DEFINING OSHA REGULATED OCCUPATIONAL MEDICINE
The OSHA regulations indirectly define occupational medical practice by
establishing what constitutes OSHA occupational medical information. By
inference, physicians generating such regulated medical information are
practicing occupational medicine as regulated by OSHA. The regulations apply to
any employer "who makes, maintains, contracts for, or has access to employee
... medical records ... pertaining to employees exposed to toxic substances or
harmful physical agents." The rules include all medical records maintained on a
covered employee--not just those mandated by "specific occupational safety and
health standards." The rules specifically include records maintained by
physicians who are not employees of the covered employer but provide medical
services on a contractual or fee-for-service basis. There are additional
regulations that require monitoring of exposure to specific toxic substances.
These regulations prevent employers from avoiding the rules on employee medical
records by ignoring employee health entirely.
It is the definitions of exposure and toxic agents that account for the broad
reach of these rules:
- --"Exposure" or "exposed" means that an employee is subjected to a
toxic substance or harmful physical agent in the course of employment through
any route of entry (inhalation, ingestion, skin contact or absorption, etc.),
and includes past exposure and potential (e.g., accidental or possible)
exposure.
--"Toxic substance or harmful physical agent" means any chemical
substance, biological agent (bacteria, virus, fungus, etc.), or physical stress
(noise, heat, cold, vibration, repetitive motion, ionizing and non-ionizing
radiation, hypo-or hyperbaric pressure, etc.) which: (i) Is listed in the
latest printed edition of the National Institute for Occupational Safety and
Health (NIOSH) Registry of Toxic Effects of Chemical Substances (RTECS); (ii)
Has yielded positive evidence of an acute or chronic health hazard in testing
conducted by, or known to, the employer; or (iii) Is the subject of a material
safety data sheet kept by or known to the employer indicating that the material
may pose a hazard to human health.
Given that the current edition of the RTECS contains over 45,000 chemicals,
including nearly 6,000 that have been added in the past ten years, it is hard
to imagine an industrial employee who is not covered by these regulations. The
addition of biological agents expands coverage to most health care workers. The
inclusion of repetitive motion and nonionizing radiation adds every office
worker who touches or sits near a computer. There are exceptions for situations
where the employer can "demonstrate that the toxic substance or harmful
physical agent is not used, handled, stored, generated, or present in the
workplace in any manner different from typical non-occupational situations,"
but these exceptions are construed strictly.