The on-site health clinic at Tesla’s Fremont, California factory prioritized underreporting workplace injuries over proper treatment and safety, according to a new report from Reveal and The Center for Investigative Reporting. The allegations build on similar claims published by Reveal earlier this year from current and former Tesla employees, and they imply that the company’s so-called Model 3 “production hell” has had serious physical consequences on the workers who put the cars together.

Reveal says Tesla’s clinic uses different methods to keep official injury counts down when they should be higher, citing company documents and the accounts of five former employees, including a physician assistant named Anna Watson who worked there for three weeks in August. In an interview with The Verge, the surgeon who took over the clinic this summer said the injury numbers were artificially inflated by the previous health care provider, and his company is now simply providing more accurate reporting.

Workers at the Fremont factory aren’t allowed to call 911 without permission from the clinic’s doctors, according to the Reveal report, allegedly because those calls would be logged and made available to the public. Lyft rides to the hospital are often prioritized over ambulances because first responders disclose severe workplace injuries, according to the former employees who spoke to Reveal. And clinic staff were reportedly told to stop prescribing exercises to hurt workers so that the injuries would stay off the books.

Watson, Reveal says, estimated that more than twice as many injuries should have been reported when she was shown official logs for the month of August.

“The goal of the clinic was to keep as many patients off of the books as possible,” Watson told Reveal. “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.”

The report also includes a number of gruesome personal accounts from injured employees.

Basil Besh, an orthopedic surgeon whose company, Access Omnicare, took over the clinic in June, declined to comment on specific cases because personal records are confidential. But he told The Verge in a phone conversation that the previous operator Premise Health “treated everything to the worst case scenario,” which led to inflated injury counts.

“The previous clinic was manned by 2 mid-level nurse practitioners. When all you have is a hammer, everything looks like a nail,” he said. “You knew that if you went to the clinic [under Premise Health], it was like going to the school nurse. You knew you were going to go home, you were going to get time off. It incentivized illegitimate behavior.”

This led to employees “gaming the system” to both get time off and abuse the state’s “cumbersome” workers’ compensation laws, he said.

Lacey Hunter, Premise Health’s director of communications, did not respond to Besh’s specific claims. “We are extraordinarily proud of the care we provide all of our members and their families; however, it is our policy not to comment specifically on current or past clients,” she said in a statement provided to The Verge.

Access Omnicare, which had previously provided care for Tesla employees with occupational injuries before taking over the clinic, has taken different approaches to reduce the number of reported injuries, Besh said. But Besh believes Reveal misconstrued the intent of those methods. According to the company’s proposal to run the clinic, which was obtained by Reveal, Access Omnicare believed there was “a tremendous opportunity for improvement” to reduce the number of reportable injuries at Tesla because they were not being properly recorded.

For instance, Besh said if Tesla workers find themselves or others in life- or limb-saving scenarios, “anyone can call 911,” but it’s not appropriate for all situations. “Every ambulance that’s called thoughtlessly or doesn’t require life- or limb-saving is one less ambulance available to save a life,” he said.

Access Omnicare also shifted away from exercise prescriptions to a more proactive “early symptom intervention” program, Besh said, in part because California’s Division of Occupational Safety and Health (Cal/OSHA) requires an affliction be classified as an injury if exercise treatment is prescribed. “This is insane for me as a physician,” he said. “That’s a guideline written by someone who doesn’t treat patients. This is artificially inflating injury rates.”

Larry Boress, the executive director of the National Association of Worksite Health Centers, tells The Verge it’s characteristic of providers to push for lower injury reporting numbers in different ways, especially because the market is competitive and growing. Around 48 percent of employers with more than 5,000 employees have some form of on-site clinic, he says.

“It wouldn’t surprise me that [Access Omnicare] would say we can help reduce reportable incidents, and to switch the focus to identifying problems early on,” Boress said, though he has not specifically followed Tesla’s on-site clinic. “Often times, if you can treat an injury or an illness early on, it may not reach that threshold [for officially reporting]. It’s not that they’re potentially preventing reportable issues from being recorded. It may be that they’re catching things earlier.”

Tesla touted the clinic on its most recent quarterly earnings call as well as in a blog post on the company’s website, calling it “cutting edge in the field of workplace health,” and highlighting the early intervention program. The company said its “injury rate has continued to trend downward in 2018,” though it did not offer specific numbers. The company claimed its injury rate dropped 25 percent in 2017.

Besh, who also runs the on-site clinic, said in a separate emailed statement that he “spent nearly one hour with Reveal detailing Tesla’s decision earlier this year to bring me and my medical team on site at Fremont.”

“Rather than deliver an informative and balanced piece of journalism, Reveal has instead chosen to hitch its wagon to Ms. Anna Watson, a provider with whom we severed ties after less than two weeks at our clinic and about whom I cannot provide any additional comment as she is currently the subject of an investigation by the California Medical Board,” Besh said in the statement. “Instead of highlighting the tremendous progress being made in both patient safety and patient care at Tesla, this report uses poor sourcing to tell a story consistent with a predetermined agenda.”

(Asked whether Watson is under investigation, Carlos Villatoro, the public information officer for the Medical Board of California, said: “The Board is unable to provide the information you are seeking as the Board’s investigations and complaints are confidential.” There are currently no disciplinary actions, malpractice judgments, citations, or reprimands filed with California’s Physician Assistant Board or with Michigan’s Bureau of Community and Health Systems, where she is also licensed. Watson did not respond to a voicemail requesting comment.)

Besh further stated that Tesla allows him to give employees the “necessary testing and treatment in a timely manner without being hindered by an often-times cumbersome California Worker’s Compensation System that can sometimes negatively affect injured workers.”

Reveal previously reported in April that injured Tesla factory workers often had trouble getting the company to properly record incidents, which some employees claimed inevitably affected the quality of treatment they received. The April report sparked an investigation by Cal/OSHA, which ultimately fined the automaker $400 over a single improperly recorded injury. The punishment’s scope was limited because of a six-month statute of limitations, which has since been changed following Reveal’s reporting. A half dozen other investigations remain open.

Tesla panned Reveal’s April report, calling it “an ideologically motivated attack by an extremist organization working directly with union supporters to create a calculated disinformation campaign” in a post on the company’s website, though it did not offer evidence to support that claim.