Page 46 - Occupational Health & Safety, January/February 2020

RESPIRATORY PROTECTION
Table 2. Silica Reports to Employee and Employer Markedly Differ
Information
To Employee
To Employer
With Employee Authorization
Medical exam results
X
Conditions placing employee at increased risk
X
Conditions requiring further evaluation/ treatment
X
Recommended limits on use of respirator
X
X
Recommended limits on exposure to silica
X
X
Should be examined by specialist in OM/PD
X
X
Results Explained to employee
X
prior standards. Areas of confusion include:
■ Which employees need silica medical exams
■ The information needed for the exam and the specific tests
to be performed
■ Specific examination results the employer may and may not
receive
■ Chest x-ray, B-Reading and TB skin test interpretation
■ Appropriate employee follow-up, especially with designated
specialists
■ Payment for follow-up exams
To understand and interpret the new standard, employers
should seek the guidance of experts who have experience in silica medical exams and respiratory protection.
Challenge 2. Employee refuses any part of exam: While a sili- ca medical examination must be offered, employees can choose not to have the exam or any component of it. An employee can decline to complete the work and medical history, pulmonary function test, chest x-ray with B-Read, physical exam, TB skin test or refer- ral to a broad-certified specialist for follow-up.
Although employees can refuse any OSHA-mandated test, it is important to note that employers have the option to make medical exams a mandatory “condition of employment.” When looking for a medical partner for silica exams, seek a company that aims to teach workers the value of each component of the silica medical exam and the benefit to their health.
Challenge 3. Training of licensed health care professionals:
Given the confusion surrounding the new silica standard, it is diffi- cult to find competent and knowledgeable silica examiners. Unfor- tunately, not all medical examiners understand OSHA regulations and fully comprehend their role in the process. In fact, many sim- ply review history, perform physicals and complete forms. Examin- ers need guidance on potential hazards, information to search for in work and medical history, how to focus their physical exams, knowledge of the required tests and how to interpret results, and clear understanding of the written medical opinions they must pre- pare for the employee and the employer.
Challenge 4. B-reader licensing: There is confusion about the credentialing needed for NIOSH-certified B-Readers to review sili- ca x-rays. OSHA has not provided guidance on whether B-Readers must hold licenses in each state where they conduct B-Reads. Some B-Readers are attempting to distinguish comprehensive “clinical review” from occupational “pneumoconiosis consultations” to avoid dealing with state licensure issues.
Challenge 5. Assistance finding qualified medical specialists for referral: After the silica medical examination, employers must “make available within 30 days an evaluation by a board-certified
specialist in pulmonary disease or occupational medicine” for em- ployees with work-related silica health issues. Locating properly qualified medical specialists presents difficulties. Employers should work with a partner who can provide assistance in finding suitable specialists when needed.
Challenge 6. Employee does not authorize release informa- tion to employer: Only with a signed release can employers access the critical employee information from the initial medical exami- nations (See Table 2). Information includes recommended limita- tions on employee exposure to respirable crystalline silica and a statement directing an examination by a board-certified specialist in pulmonary disease or occupational medicine for the employee.
Look for a partner that guides workers to understand the best options for their health. Health professionals should discuss with employees the implications of not authorizing their employer to receive vital information.
Challenge 7. Confusion about what medical information the employer may receive: Employers usually receive medical exam results relevant to occupational exposures. However, the silica standard excludes employers from receiving: medical test results, medical conditions that would place employee at increased risk from silica exposure and medical conditions that require further evaluation or treatment (See Table 2). Only with employee autho- rization may an employer receive a statement that a board-certified specialist in pulmonology disease or occupational medicine should examine the employee. Employers must understand how significantly the silica rules differ from other OSHA standards.
Conclusion
Navigating the complex landscape of OSHA regulations can be tricky. The new silica standards complicate this further. In fact, they can be more difficult to understand than previous rules. Employ- ers should look for a compliance partner who has the experience, knowledge and insight that can help them navigate OSHA silica con- fusion and keep their workforce productive, safe and healthy.
Kent W. Peterson is Chief Medical Officer of Examinetics. REFERENCES
1. https://www.osha.gov/laws-regs/regulations/standardnumber/ 1926/1926.1153
2. https://www.osha.gov/silica/factsheets/OSHA_FS-3683_Silica_Overview.html 3. https://monographs.iarc.fr/agents-classified-by-the-iarc/
4. https://www.osha.gov/silica/AppendixBtosect1926.1153.pdf
42 Occupational Health & Safety | JANUARY/FEBRUARY 2020
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