Sunday, April 10, 2005

Rep. Wicker Continues War On Health Care Workers

Someone should strap an ill-fitting respirator on Roger Wicker (R-MS) and lock him in a ward with infectious tuberculosis patients for a couple of weeks.

Wicker is the Congressman from Mississippi whose focus in life seems to be making sure that health care workers get exposed to tuberculosis (TB). Whether the source is the usual payola (e.g. campaign contributions) from the health care industry, or some bad childhood experience with an evil nurse, only Roger (or his shrink) knows for sure.

You may recall last Fall, Wicker successfully introduced a rider on OSHA's appropriations bill prohibiting enforcement of annual fit-testing for workers who wear respirators to protect themselves from tuberculosis. (Technically, the way riders work is that Congress is not telling the agency to actually change the standard, it's telling the agency that it's not allowed to spend any Congressionally appropriated money to enforce that part of the standard.)

A little background, in case you don't recall. When OSHA issued its new respirator standard in 2000, they didn't cover health care workers exposed to tuberculosis because they were going to be covered in the new tuberculosis standard. When Bush's OSHA killed the tuberculosis standard at the end of 2003, the agency (correctly) decided that health care workers who may be exposed to TB would be covered under the general respirator standard (like every other worker who wears a respirator) and required to have annual respirator fit tests (like every other worker who wears a respirator.) Ask any industrial hygienist: respirators don't work real well if they don't form a tight seal around the face. OSHA has estimated that 5 percent to 50 percent of workers would lack a proper fit without annual testing.

The American Hospital Association and the Association of Professionals in Infection Control (APIC) were aghast that they would be forced to fit test health care workers and appealed to Congressman Wicker for help. Wicker sent a letter to OSHA, protesting the respirator requirements. After considering a six-month delay, OSHA finally decided to do the right thing and start enforcing the requirement on July 1, 2004. In a letter to APIC, Assistant Secretary John Henshaw rebuked the association for opposing fit testing when it was already required for hospital workers exposed to ethylene oxide or formaldehyde.

But appropriations riders expire after the end of the Fiscal Year (September 30) and it's kind of a drag having to submit a rider and lobby for it every single year. Wicker figured it was better if he could just OSHA to permanently change the standard. So in January, Wicker sent Henshaw a letter requesting that OSHA permanently withdraw health care workers exposed to TB from the respirator regulation.

To its credit, OSHA refused, and acting Assistant Secretary Jonathan Snare was forced to explain in a letter to the good Congressman that in order to permanently change an OSHA standard, OSHA would have to conduct full notice-and-comment rulemaking. It must have been a shock to Wicker, but it also turns out that in order to issue or change a standard, OSHA has to have some kind of scientific justification.
As part of sustaining a successful rulemaking, the agency would need to scientifically justify that TB droplet nuclei behave differently than other airborne particulate contaminants and necessitate a different regulatory approach to the question of respiratory protection. OSHA is not presently aware of a body of scientific evidence demonstrating this relationship.

Snare also cited the inconvenient fact that the Centers For Disease Control recognizes the importance of "periodic fit testing."

So, now that it's appropriations season again, the odds-makers are betting that being as Wicker has failed to get OSHA to change the standard permanently, he will once again show his industry friends that their campaign contributions are well spent, and re-introduce a rider ensuring that health care workers continue to be exposed to tuberculosis.

These are the kind of "little things" that happen in Washington, far from the headlines or evening news that have very real and potentially devastating impacts on workers -- in this case, our nation's caregivers. While normal tuberculosis is curable with a long, difficult drug treatment (rife with side-effects), drug resistant TB can often mean a death sentence to workers, or family members that they may inadvertently expose.

It's not enough that they repeal the ergonomics standard, sentencing health care workers to disabling career-ending back injuries.

We'll keep you posted. Might not be a bad thing to talk to your Congressman about when the time comes.

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