Document ba2nDqZzmedkdxbBDwDQmLDVO

REPORT OF VISIT TEXAS CITY. TEXAS NOVEMBER 2 AND 3, 1983 PLAINTIFF'S EXHIBIT MON-2330 DISTRIBUTION D. Sendejas, R.N. P. E. Burke, R.N. B. J. Culbreth, R.N. K. G. Christian, M.D. J. O'Bryant, M.D. G. L. Tromblee J. S. Haygood G. W. Daues D.K. Kaldenberg R. T. Hammann cc: C. F. Callis D. L. Coleman, M.D J. S. Spraul, M.D. -SrDn'Paul- ^ PLANT POPULATION Hourly ........... 885 Salaried..... 565 1,448 (October, 1983 Headcount) STAFF FULL-TIME Dora Sendejas, R.N., Chief Nurse. Employed at this location ten years. Assumed chief nurse position, 1981. Previous professional experience in mental health nursing.. Patricia Burke, R.N. Employed at this location four years. Previous professional experience in coronary care and intensive care nursing. Betty Culbreth, R.N. Employed two and one half years at the Texas City plant. Previous experience includes: medical, emergency room, intensive care, and coronary care nursing. (NOTE: The three nurses have baccalaureate degrees in nursing - a requirement for the Texas City occupational health nursing position. This Monsanto location is the only one to require the BSN and the sole location where BSN nurses are employed.) The nurses share in all services offered by the medical department but have some prime areas of responsibility: Mrs. Sendejas in administrative function; Mrs. Burke in employee health education; and Mrs. Culbreth in the Hearing Conservation Program. Kenneth G. Christian, M.D. - has been employed full time since September, 1982; previously the physician at the Monsanto Sand Mountain location. PART-TIME J. O'Bryant, M.D. is employed as a part-time contract physician and spends approximately two hours per week on site. LAM001155 MAP 005328 REPORT OF VISIT TEXAS CITY, TEXAS 2 MAP 005329 FACILITY The facility is located in a building also housing the employee cafeteria and administrative offices. The medical department has a central area where employees fill out examination forms. The nurse's desk is located in the same area along with partitioned areas for first aide treatment. There are three smaller rooms used for physical exams, phlebotomy, EKG's, spirometry, and audiometric testing. The medical files and physician's office are located across an entrance hallway from the main area. There is not a reception area and employees push a buzzer to request entrance. The nurse's talk to the person wishing admittance through an intercom system. Although the facility is adequate in some ways, the physical layout could be improved (SEE RECOMMENDATIONS). SERVICES PROVIDED Preplacement examinations are performed according to established DMEH guidelines. The routine physical examination schedule is defined differently; this does not present a problem for data entry or useability in the MEHI system. The routines are presented on the attached form (A) "Medical Surveillances - Physical Examinations." Hands on portions of the exams are performed by Drs. Christian and O'Bryant. Other portions of the physicals are performed by the nurses. With the exception of medications to be used in emergencies, medications dispensed are of the over-the-counter types. METPATH has been utilized for laboratory services since February, 1983. The MIECA (Monsanto Industrial Emergency Care Attendants) team members training is done in-house. The Safety Supervisor and the Chief Nurse share the responsibility for coordinating this 40 hour training course. The course is taken at the College of the Mainland. Medical and Safety Personnel provide instruction and updating on skills and current information. (Texas State Certification is optional). There are approximately 250 employees who have completed the training. Each unit has a posted list of individuals who have completed the first aide course. The number of workers who have received training insure 24 hour coverage. An ambulance is available on site for transport of ill/injured employees during the day shift and is driven by one of the two paramedics. On the evening and night shifts, a local ambulance service is used. The Emergency Room treatment facility is approximately 5 minutes from the plant. POLICIES, PROCEDURES AND MEDICAL DIRECTIVES These are clearly written, current, and are signed by both the Chief nurse and physician. AUDIOMETRIC TESTING LAM001156 Audiometric testing is done using a Belltone 9D Manual audiometer. Representatives of the Audio Electronics firm come to the site once a year for exhaustive calibration of the audiometer and booth (completed April, 1983). REPORT OF VISIT TEXAS CITY, TEXAS 3 Biological monitoring is done with a Tracor Oscar Ear. The Belltone 9D audiometer meets ANSI standards. The three nurses are CAHOC certified in audiometry. Mrs. Sendejas is due for recertification in 1984 and the other two nurses in 1985. SPIROMETRY Basic pulmonary function testing is accomplished using a Spirotech 300 (new November 1983). Patti Burke completed the spirometry training course in November, 1983 and is certified. Mrs. Sendejas and Mrs. Culbreth will complete training courses as courses and scheduled time are available. The spirometry equipment is NIOSH approved. X-RAYS Chest x-rays are taken at the near-by Beeler-Manske Clinic. Chest x-rays are taken as part of the pre-employment physical and every other physical exam for other employees. Exceptions to this are workers who are under surveillance exams involving Acrylonitrile and Asbestos: X-rays taken annually. EKG'S Performed on site at age 35 and every 5 years thereafter-or as medically indicated by condition and/or symptoms. MEDICAL RECORDS Contained in locked file cabinets outside the physician's office and across the hallway from the main medical area. This is not viewed as an "ideal location" in terms of access and insuring confidentiality. (See recommendations). Keys to the files are kept by medical personnel. Should the necessity for an employees medical record exist when medical personnel are not on site, the night supervisor and safety superintendent have access. OSHA 200 FORM The OSHA 200 form is maintained in the medical department. To date for 1983 there have been ten (10) recordable injuries (one injury is not finally determined as to OSHA recordable). Six (6) of these injuries have involved trauma to hands and five (5) of the six (6) have occurred in the maintenance worker group. Safety programs have been presented to address the increased and prominent injury rate involving the hand. MEHI MEHI forms are in use and MEHI information is up to date with the exception of 141 baseline audiograms involving retired, resigned, discharged, or deceased employees. MAP 005330 LAM001157 REPORT OF VISIT TEXAS CITY 4 RECOMMENDATIONS The following recommendations are made for consideration. Many of these were discussed in meetings with Medical Department personnel and plant management during the visit. 1.0 Medical Department Facility: As discussed, the medical department physical design is in need of change and renovation in order to more effectively meet objectives of the employee health department. 1.1 Physician and nurses office: -Presently the physicians office is located across a hallway from the main medical facility. The office is small, noticeable especially if the door is closed for privacy. The nurses desk is located in the middle of the main treatment area and affords no privacy for employee counseling and teaching. 1.2 Entrance to Medical Department: -The entrance to the medical department is located in a hallway and employees use an intercom to gain admittance. This hallway is utilized by persons going to the employee cafeteria and is also a thoroughfare for access to administrative offices. This public corridor and rather impersonal intercom system may be inhibiting to the employee and does not support confidentiality. 1.3 Medical treatment and Emergency Care: -Although space is adequate for routine and first aide treatment, care of a seriously ill or injured employee would be hindered with the present physical layout: i.e. transport of a stretcher would be difficult. Although the community ER facility is in close proximity, providing for treatment/stabilization of an emergency situation is important. 1.4 Medical Record Files:- Space provided within the main area of the medical department would be more condusive to insuring confidentiality and also be more convenient for the medical staff. 2.0 Audiometric Equipment: The present equipment meets ANSI standards; however, it is suggested that consideration be given to purchasing a more efficient and cost-effective audiometer (self-recorder or micro-processor). The Belltone 9D is a discontinued model. Should repair of this equipment be necessary, parts may not be available. Dr. Carl Bohl (DMEH, EXT. 8833) is available for consultation regarding available models and cost. 3.0 Emergency Care Attendents: Cooperative efforts for the training of these individuals involves both the medical and safety departments. It is recommended that scheduling and responsibilities of these Map 005331 LAM001158 REPORT OF VISIT TEXAS CITY, TEXAS 5 RECOMMENDATIONS (CONTINUED) individuals be more clearly defined for all shifts. Since this visit the chief nurse indicated that efforts are currently underway regarding the recommended scheduling. 4.0 Courses, Conferences, and CEU's For The OHN It is recommended that management continue to support the nurses in attending courses/conferences that provide current information regarding occupational health nursing. The accountable nurse must keep pace with nursing practice through continuing education in order to practice safely. It is Monsanto's DMEH goal that nurses be certified in occupational health nursing. Continuing education hours are required to complete the examination and also to maintain certification. Many states require validated CEU credits to maintain licensure as a registered nurse. Although Texas has not adopted this policy, it is probable that this will be required in the future. 5.0 Plant Visits by Medical and Nursing Personnel It is recommended that the nurses, and physicians visit the plant with industrial hygienists and safety personnel on a regularly scheduled basis. One member of the nursing staff, one member of the medical staff, and one member of the industrial hygiene and/or safety staff should visit a designated area of the plant together. The rationale for this recommendation is that these visits would serve to: 5.1 Increase the understanding of the medical and nursing staff with the plant facility - the areas where the employees they care for spend their working hours. 5.2 Promote public relations by being visible in the worksite. Too often the only association between the personnel of the medical department and the employees is during routine health screening, injury or crisis. 5.3 Assist in identifying health and/or safety concerns using a multi-discipline approach. Each person can make contributions based on a somewhat unique viewpoint. 6.0 CLERICAL ASSISTANCE It is recommended that consideration be given to providing clerical assistance for the medical department to support answering and screening phone calls, and handling the voluminous amount of paperwork. The nurses are very interested in time to do more employee health education and health promotion. Having clerical assistance would create additional time for the nurse's involvement in such programs. LAM001159 MAP 005332 REPORT OF VISIT TEXAS CITY, TEXAS 6 During the visit to the Texas City location, meetings were held with the nurses, physicians, plant manager, personnel staff, industrial hygiene and safety personnel. A tour of the plant was conducted by Doug Barfoot, safety engineer. The members of the medical staff are very knowledgeable and enthusiastic. I feel that many positive changes can occur with attention to change in the physical facility. PatriciaE. Hunt, ft. N. Health Services Coordinator /ss Addendum: In the interim between the date of the visit and the writing of this report, several phone conversations have taken place with the nurses and with the Superintendent of Personnel. Discussions are underway regarding changes in the medical department -- both managerially and in the physical facility. 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