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, 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, which means there are
very few exceptions.
