Document kD5amx78wg607JBYpbVyeOw5O

Federal Register / Vol. 51, No. 119 / Friday, June 20, 1986 / Rules and Regulations 22729 15 and the determination of an employee's Technology) also suggested that medical fitness to wear and use a respirator" (Tr. tests be given every three years to I 7/3). reduce the frequency of X rays (Tr. 6/ j Respondents disagreed about how. 25): and Dr. Hans Weill, of Tulane | frequently medical tests and chest X University, questioning the usefulness of . rays should be required.AU of those annual examinations, agreed that this . ! ( who commented on pre-placement frequency was appropriate (Tr. 6/19). exams agreed with OSHA that The National Institute for j employees engaged in asbestos work Occupational Safety and Health - ; ; should receive a pre-placement medical (NIOSH) recommended that a i ; examination (EXs. 64-424,64-457,123.A, comprehensive medical examination be j : 312.A; Trs. 0/21, 6/28, and 6/29). ORC given every five years for the first fifteen | . indicated that "a pre-placement medical years of occupational exposure to j : evaluation should be designed to asbestos and "thereafter every two. j > determine the suitability of the years using the standardized guidelines individual for the job and vice- for instrumentation training and . versa ... it is important to establish interpretation of the recognized expert l baseline data for longitudinal authorities" (Tr. 6/21). The American i f prospective follow-up" (Ex. 123.A). The Iron and Steel Institute (A1SI) -- j t American Association of Occupational recommended a reduction in the ' ( j Health Nurses (AAOHN) concurred frequency of chest X rays (Ex. 263). ] with ORC: "(djelaying gathering of this OSHA agrees that annual X rays may ' essential baseline information could be not always be necessary and believes i detrimental to both the employee and that the interval between X rays is best v die employer, because knowledge of a determined by the physician, who can r pre-existing condition could influence base his or her decision on the general ' initial job placement" (Tr. 8/26). health status of the employee and 5 However, opinions differed on the specific workplace conditions. In the ! v frequency of both medical examinations final.rule, OSHA has retained the " | ; and chest X rays given after the initial requirement for a preplacemenl .j ' exam. AGC stated that "[cjontractors examination and at least an annual 5 should not . . . have to provide more exam thereafter, but grants.to the : | than one medical examination to an physician the right to determine what - f employee in any one calendar year" (Ex. interval is appropriate. ; 84-457). The BCTD suggested that Respondents disagreed on the content. ji triennial medical exams be given to of medical examinations to determine } workers under forty years of age or with respirator fitness (Exs. 90-254, Trs. 6/29, f less than 20,000 hours of work 7/3,7/12). For example, the National | experience in the building trades and Constructors Association (NCA) stated | annual exams thereafter, except for _ that, ". . . a pulmonary function test. : . ; chest X rays, which they recommended must be performed because the j; should be performed every three years employee could be at risk in UBing . j without regard to duration of workplace respirators" (Tr. 7/12). David Kirby, an * exposure. However, the BCTD suggested Industrial Hygiene Chemist with the ` that an examination to determine an University of Alabama, felt that medical > employee's fitness to wear and use a surveillance should be used to ?, respirator be given annually. The ' determine if the employee is capable of i International Brotherhood of wearing a respirator and is physically . Boilermakers (IBB) generally concurred able to do the work, but that chest X j with BCTD's recommended medical rays and pulmonary function tests are , examinationprotocol and recommended inappropriate for the asbestos . f that "for those post-40 or with 20,000 I hours ormore of employment, the . abatement industry (Tr 6/20). OSHA has -determined that.pulmonary function . medical examination should be provided tests serve a dual purpose in this Final (annually. . . ." (tr. 7/3). However, the Rule. In addition to establishing ' IBB felt that a chest X-ray should be respirator fitness, spirometric '{ included in-this annual examination. measurements can detect lung fibrosis ? The Asbestos Victims of America due to asbestosis. Therefore, pulmonary |. (AVA) also agreed with the BCTD that function tests are required in this employees at least 40 years of age standard. ; - should be provided with medical The issue of whether to include ! . examinations on an annual basis (Tr. 6/ mandatory dr recommendatory medical | : 26). Scott.Schneider, of the Carpenters tests in the revised'standard was i ; Union, recommended one exam every controversial. Some commenters argued ; three'years after the initial exam, for that certain tests should be required > those employees just beginning to work (Exs. 277, 330. Trs. 6/26; and 7/3), while with D8be8tos (Ex. 84-424): William others maintained that the tests should 1 Ewing Jr., of.the Georgia institute of be chosen by the examining physician rather than by OSHA (Exs. 312.A, Trs. 6/21, 7/12, 7/10). The following commenters suggested specific tests: BCTD stated that OSHA should require "... a rectal exam and stool guaic test for occult blood [for asbestos-exposed workers] after the age of 40" (Exs. 277, 230): the Oil, Chemical and Atomic Workers Union (OCAWU) recommended a stool test to screen for gastrointestinal malignancies and sputum cytology tests to screen for lung cancer (Tr. 6/26): and the International Brotherhood of Boilermakers advocated annual tests for digestive tract cancer for employees over the age of 40 or with 20.000 hours or more of employment (Tr. 7/3). However, many respondents supported permitting greater discretion on the part of the physician in determining what tests to conduct. For example, NIOSH recommended that "(the use of] routine periodic stool, sputum cytology and lavage tests . . . should be left to the discretion of the examining physician" (Tr. 8/21), and Dr. Hilton C. Lewinsohn,.Assistant Corporate Medical Director of Union Carbide, stated that, as a physician, he doesn't want to be ". . . confined to doing certain things in a medical examination or a physical examination" (Tr. 7/12). In the final rule, OSHA has struck a balance between mandatory and nonmandatory medical survejUance requirements: the requirements for medical and work history, physical examination, and pulmonary function tests are mandatory, while the selection of Other specific tests to be conducted has been left to the discretion of the examining physician. Choosing this cut off point on the continuum between performance standards on the one hand and specification standards on the other reflects, in OSHA's view, the record evidence in the case of asbestos. In addition, mandating certain basic elements of the medical surveillance program and stating others in nonmandatory terms follows the precedent established in OSHA's final rule for ethylene oxide (29 CFR 1910.1047). Some commenters supported the administration of a questionnaire during the medical examination (Exs. 84-424, 90-138 and 90-162). Monsanto felt that a respiratory disease questionnaire should be issued in conjunction with the pulmonary function tests (Ex. 90-138). . James Packenham, of OSHA's Advisory. Committee for Construction Safety and Health, suggested that ". . .because of the nature of construction . .'. there has to be a rather thorough questionnaire in the appendices ... . which will facilitate .i-.ii i i i :) Id & GLEASON-000977