For eight years, Dora worked at a frozen pizza factory in Romeoville, Illinois, called Great Kitchens. For eight hours a day — sometimes seven days a week — she assembled pizza boxes or arranged cheese and other toppings on pizzas. The consequences of years of such repetitive work surfaced in October 2012, when her hands would go numb and a painful cyst formed on her left wrist. She told her supervisor about the problem, but he said he couldn’t do anything about it — Dora was a temporary worker hired through a staffing agency and so Great Kitchens wasn’t responsible for addressing her injury.

“I went to the temp agency and they told me to just put a bandage around it and use ice and they would send me to work the next day,” said Dora, 36, who asked me not to use her last name. “It was seven months later that they sent me to a doctor because I couldn’t work anymore.”

Unfortunately, Dora’s experience has become a typical one among temporary workers, as more and more corporations outsource their hiring to temporary staffing agencies and effectively absolve themselves of the legal responsibility of ensuring safe and healthy workplaces that adhere to labor laws. In other words, Dora and other temporary workers are considered employees of the staffing agencies, not the factory or office in which they actually work. That means it’s the staffing agency that takes on the workers’ compensation liability, which weakens the incentive for the onsite supervisors to enforce health and safety standards.

It’s a problem that’s growing bigger and bigger as more major corporations — from Wal-Mart to Nike to Arizona Iced Tea — look to staffing agencies to take over key production operations. And as those staffing agencies race to underbid each other and compete for lucrative contracts, it’s the workers who ultimately suffer. In a new report from the National Employment Law Project (NELP), “Temped Out: How the Domestic Outsourcing of Blue-Collar Jobs Harms America’s Workers,” authors Rebecca Smith and Claire McKenna write:

Our country is in the midst of a seismic change in how businesses organize the way that work central to their success is carried out. It’s a change that can have dire consequences for workers. In recent decades, major employers across the economy have restructured, franchising their businesses, outsourcing, and using staffing agencies to take over core operations. While these practices sometimes may yield greater efficiencies, too often they reflect explicit employer strategies to evade labor laws and worker benefits. And even when not implemented with such intentions, the effect can be the same, as “lead” companies for which workers are producing goods or providing services disclaim any employment relationship with them. Thus, at the same time that major corporations continue to closely direct the provision of their services and the manufacture of their products, they attempt to shed responsibility for compliance with core labor standards.

According to the report, which was released earlier this month, temporary work has reached an all-time high in the U.S., with 2.8 million Americans employed in temporary help services. In addition, temporary work is moving from the office to the factory, with production and material moving jobs making up 42 percent of temporary staffing jobs in 2013, and office and administrative jobs making up just 21 percent. Within this growing business model, injured workers or those who’ve experienced wage violations are left navigating a confusing maze to determine who’s responsible.

When Dora’s temporary employer, Staffing Network, finally sent her to a doctor, she was diagnosed with carpal tunnel syndrome and told she had to undergo multiple surgeries to correct the damage in her hand, wrist and elbow. But Staffing Network refused to cover all the care her doctor recommended. So with the help of a local worker advocate organization, the Chicago Workers’ Collaborative, Dora sued the temp agency. (The lawsuit is still in progress and is now against Great Kitchens after Staffing Network’s workers’ comp provider went bankrupt.)

“Honestly, this has really affected me a lot because I am a single mother, I have three children…so to even make them food, to wash them, to give them the attention they need is very difficult (because of the injury),” Dora told me. “It makes me feel helpless.”

However, Dora’s experience compelled her to become an advocate for other workers, and today she is a health and safety promoter with the Chicago Workers’ Collaborative.

“I don’t think it is just that they abuse us because we don’t know our rights,” she said. “They think that because some of us might be undocumented that we don’t have any rights to anything. It’s what compelled me to learn about my rights and how to help one’s self and to help others who need it. …I think it’s really important that people know that we don’t need to be afraid, that we need to speak up.”

Temporary workers join forces to fight workplace abuses

According to the NELP report, staffing agencies often hire the most vulnerable workers, with Hispanic and African-American workers comprising about 40 percent of the staffing industry. Also, temporary workers tend to report higher work-related injury rates than workers in more traditional employment arrangements, experience a higher incidence of retaliation for speaking up and are paid less on average. NELP reports that the median staffing agency worker earns about 22 percent less than other workers. To top it off, staffing agency workers are excluded from the bargaining and organizing rights authorized via the National Labor Relations Act (NLRA). The NELP report states:

Staffing workers face a perfect storm of health and safety risks. They work in some of the most dangerous jobs in our economy. According to OSHA, temporary workers often receive insufficient safety training and are more vulnerable to retaliation for reporting injuries than workers in traditional employment relationships. … A ProPublica analysis of worker’s compensation claims in California, Florida, Massachusetts, Minnesota, and Oregon found that the incidence of temporary worker workplace injuries was between 36 to 72 percent higher than for non-temporary workers. Perceived job insecurity can also have negative physical and mental health consequences, so that temporary workers may experience increased levels of depression and anxiety because of their contingent status.

Rebecca Smith, a co-author of the report and NELP’s deputy director, told me that third-party employment is becoming a permanent feature of many business plans and is expected to be one of the fastest growing sectors of the next decade.

“From a worker’s perspective, it creates confusion over who’s the boss and over who’s supposed to train you and provide health and safety equipment,” she said. “It can prove fatal for some workers.”

Smith said that today’s labor laws, such as the NLRA, are not equipped to “deal with this fracturing of the employment relationship.” However, the tide may be slowly changing. OSHA is increasing its focus on temporary workers and is working with staffing agencies to make sure they’re aware of their legal obligations. According to the NELP report, OSHA is ramping up its temp worker-related data collection and enforcement activities through its Temporary Worker Initiative. (On the OSHA site, agency administrator David Michaels is quoted as saying: “Host employers need to treat temporary workers as they treat existing employees. Temporary staffing agencies and host employers share control over the employee, and are therefore jointly responsible for temp employee’s safety and health. It is essential that both employers comply with all relevant OSHA requirements.”)

State policy-makers are also stepping up. For example in August, California lawmakers passed a law that would hold companies legally responsible if temp agencies or subcontractors violate workers’ rights. And across the country, staffing workers are coming together to fight for better working conditions — the NELP report highlights successful campaigns in Chicago, New Jersey and Massachusetts.

“We need to ensure that the companies at the top are taking responsibility for the workers at the bottom,” Smith said. “We need to enforce existing laws, we need to change the laws and we need to ensure that workers can come together.”

Fortunately, temporary workers aren’t waiting for the law to catch up with the realities of modern work. In Illinois, despite their exemption from the organizing rights given under the NLRA, temporary workers have come together to create the Staffing Workers Organizing Committee, an association that can collectively put pressure on employers to improve workplace conditions. The Chicago Workers’ Collaborative supports the committee, providing health and safety education to committee members and helping them arrange meetings and inspections with local OSHA staff. For example, just this summer, the collaborative helped workers identify 40 dangerous worksites and is now turning the evidence over to OSHA, said Tim Bell, the collaborative’s organizing director and coordinator of the temp worker health and safety program.

“Before this whole industry was operating in the shadows,” Bell told me. “And now they’re going to have to clean up their act. …If (this employment model) is profitable in one sector, there’s going to be companies that want to use it to maximize profits in their sectors as well. Even if you’re not morally outraged by this, it could affect you one day.”

Bell said temporary workers often work in dangerous jobs and receive little training and inadequate protective equipment. The majority of injuries he sees among temp workers are repetitive motion injuries, which can “destroy the productivity of that worker and so they’re not employable again and end up being essentially disabled,” he said. (Unfortunately, OSHA has no authority to enforce ergonomic standards.) Bell noted that traditionally, many temporary jobs may have eventually turned into permanent positions directly with the host company, but that’s not happening today. In the Chicago area, he said, you’d be hard-pressed to find a direct-hire job in a factory or warehouse.

“This is a system that’s pushing health and safety standards to the bottom,” Bell told me. “The idea is to push the liability back on the host employer — that’s where the leverage lies.”

Former Staffing Network employee and Great Kitchens worker Marcela hopes she can help make that happen. Marcela, 32 and who asked I only use her first name, was a temporary worker at Great Kitchens for 18 months, assembling frozen pizza boxes for companies such as Wal-Mart, 7-11 and Costco. Between Marcela and about six to eight co-workers, they’d assemble about 80 boxes per minute. They couldn’t slow down or the pizzas would pile up.

After doing the work for six months, Marcela told me her hands would fall asleep at night, she began experiencing pain in her hands and arms, and a cyst formed on her right wrist. She told her supervisor at the factory about the pain and they sent her back to Staffing Network, which told her to put ice on her wrist and wrap it in a bandage. Between November 2012 and May 2013, Marcela treated her injury with ice and a bandage, watching the cyst grow bigger and bigger.

Finally, the pain was too much and Staffing Network sent her to their doctor, who recommended surgery for carpal tunnel. After the surgery, Staffing Network sent Marcela back to work just days later even though she had just one working arm. Both Marcela and Dora filed complaints with OSHA and requested OSHA injury logs from Staffing Network and Great Kitchens. The logs revealed that Great Kitchens was home to dozens of work injuries over the previous 18 months; Staffing Network never provided a log. Marcela also filed a lawsuit against Staffing Network, which is when she said she began experiencing significant workplace retaliation.

Like Dora, Marcela became a health and safety promoter with the collaborative and said that she believes “change is possible.”

“I got really angry at knowing and realizing that it didn’t matter…that they would treat people as disposable,” she said. “To hear (workers) cry in the bathroom and in the lunchroom, complaining about the pain they feel in their hands and wrists and knowing that it’s because they’re afraid that they can’t speak up. …(Change) is difficult, but it’s possible, even if it’s just one person that speaks up.”

To learn more about the issues facing temporary workers, download the full NELP report and read this investigative series on temp work from ProPublica. Recommended practices for protecting temp workers from the National Institute for Occupational Health and Safety can be downloaded here.

(Special thanks to Tim Bell for arranging the interviews with Marcela and Dora and to Irene Romulo for providing translation during the interviews.)

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.