Saturday, January 03, 2004

OSHA Announces "Enhancement" Of Worker Protection by Withdrawing TB Standard.

Orwell Rolls Over in Grave

Someone in the OSHA Press Office should be writing for the Onion.

But first, the FACTS.

  1. OSHA officially withdrew the proposed Tuberculosis standard Wednesday (conveniently on New Year's Eve). OSHA had originally announced its intention to withdraw the standard last May

  2. At the same time, OSHA announced that health care workers potentially exposed to TB would now be covered by the revised 1998 respiratory protection standard, instead of the old 1974 standard. Respiratory protection for workers exposed to TB was going to be handled in the TB standard instead of the new respiratory protection standard because in 1998 there were still outstanding TB-related respirator issues and the release of the TB standard was thought to be imminent. So, instead of bringing these workers into the new standard, they were to be covered "temporarily" under the old respirator standard.
Now, for the "funny" part. Here's how OSHA announces the withdrawal of yet another worker protection:
WASHINGTON -- The Occupational Safety and Health Administration (OSHA) announced it is extending the same high level of respiratory protection to workers exposed to tuberculosis that is provided to workers throughout general industry. This enhancement results from OSHA's decision to withdraw its 1997 proposal on tuberculosis.
It's a good thing these guys aren't writing press releases for the Department of Defense:
WASHINGTON -- The Department of Defense (DOD) announced that several hundred soldiers stationed in Iraq will be spending their holidays back in the United States. This benefit results from the fact that they were wounded in combat.
So OSHA will have us believe that the agency is actually doing workers a favor by withdrawing the TB proposal, overlooking the fact that the only reason health care workers remained covered under the old respiratory standard is that OSHA has failed for the past three years to issue the TB standard with the updated respiratory protections?*

I critiqued in a previous article OSHA's flawed reasoning for withdrawing the standard despite the fact that an estimated 2 billion people -- one-third of the world's population -- are infected with the bacteria that cause TB, and that TB is still a major problem among minorities and recent immigrants in the U.S., AND despite the fact that the National Institute of Medicine (IOM) says a standard is needed, AND despite the new threat of SARS which requires the same precautions as TB.

But I want to spend more time now on one part of OSHA's Federal Register notice. One of OSHA's main arguments was that an OSHA standard was not needed because Centers for Disease Control (CDC) Guidelines were taking care of the problem. The unions representing health care workers and the IOM had contended that even with the CDC Guidelines, an OSHA standard was needed because CDC Guidelines are not enforceable.

OSHA's response:
In response to these arguments, OSHA acknowledges that a standard is often the most efficient way of assuring that employers reduce their employees' exposure to specific hazards. TB is primarily a public health hazard, however, and occupational exposure at this time is in large part a function of the prevalence of active TB in the population at large. There has been a decade-long decline in TB prevalence.
That all sounds strikingly similar to the pass-the-buck reasoning that OSHA originally used in the mid-1980's to argue that the agency had no business addressing bloodborne pathogens such as AIDS and hepatitis B because they were "public health problems," not workplace problems.

Other reasons a standard is not necessary, according to OSHA:

  • Employers have "wealth of information and expert resources to assist in TB control efforts." This fits well with the general OSHA philosophy that the only thing employers need to do the right thing is a little information.

  • Among other "incentives" that employers have, according to OSHA, are the requirement that "hospitals and nursing homes must have infection control plans to qualify for Medicaid and Medicare reimbursement, and are subject to annual reviews to verify their continuing compliance."

    Health care institutions have always had infection control plans, but they are mainly designed to protect other patients, as opposed to workers, and take an approach that is very different from the occupational safety programs that finally proved effective in controlling hepatitis B in health care facilities. And you'll grow old and gray trying to find a health care institution that lost its Medicaid or Medicare certification because of lax TB precautions.

  • OSHA also assures us that "The Joint Commission for the Accreditation of Healthcare Organizations (JCAHO), which many hospitals and nursing homes use to demonstrate qualification for Medicare and Medicaid reimbursement, also requires an infection control plan as a condition accreditation."

    This statement would also get a hardy laugh out of most health care workers who work long, hard hours in the days before scheduled JCAHO inspections to get their facility in ship-shape before the inspectors arrive. OSHA, on the other hand, conducts unannounced inspections.

  • My personal favorite justification is OSHA's reliance on employers' memories. "The record also shows, as does CDC's new TB elimination plan, that the sobering memory of the 1985 - 1992 TB resurgence is not likely to fade anytime soon, and that the complacency that led to that resurgence is unlikely to recur."

    How can the "record" show that memories are "not likely to fade anytime soon" or that complacency is "unlikely to return?" The thing about memories, as some of us are realizing, is that you don't really realize that your memory has faded until something reminds you -- and by then it's often too late. You only have to look as far as NASA to see that their "sobering memory" of the Challenger disaster didn't stop the disintegration of Columbia.
But more dangerous is the complacency and fading memories that inevitably result from inadequate funding for important priorities. Even with federal funding for bioterrorism initiatives, it is questionable that states undergoing budget crises have adequate resources to fund other public health priorities like TB prevention, especially when the nation's main workplace safety and health agency claims that there is nothing to worry about.

*Yes, I know, it would have been nice to have issued the standard in 2000 before the regime change. Of course, look at what happened to the ergonomics standard.