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Health Policy Advisory Center No. 44 September 1972 HEALTH / PAC BULLETIN Editorial: iD a WORKERS ' SAFETY pational accidents and disease take their toll all over the nation: parathion spray poisons farm workers in California; lung cancer kills Johns Manville - asbestos workers in New Jersey; fires burn oil- workers in Texas refineries; and carbon monoxide fells tunnel workers in New York City. Still, word of these troubles is barely audible. If murmurs are heard of occupational accidents and disease which wreck the body, not even whispers chronicle the in- dustrial processes which slowly corrode the mind: the noise of a garment factory; the boredom of an assembly line; and the regimented nervousness of the telephone company switchboard. AND The Occupational Health Establishment Paralleling the general ignorance of occupational illness is an even greater paucity of knowledge about the occupa- tional health establishment. But such an HEALTH establishment does exist. In almost com- plete isolation, it has been left the job of attending to those occupational - related diseases on which the health science schools, doctors and hospitals have all but turned their backs. The fact is that the mainstream medical establishment shows scant respect for its occupational health counterpart. Its snobbishness is not al- together without cause. Even the Amer- ican Medical Association has observed Occupational diseases seem very remote from our experience. We read about Ap- that company doctors and nurses are pri- marily concerned, not with the mainte- nance of the workers'health, but rather palachian coal miners trapped in the with the maintenance of their companies ' latest mine disaster. And we observe production and profits. What is true miners on TV, from time to time, wheezing about the company doctors specifically, to an early death from black lung disease. is true generally about the entire occupa- But it all seems unreal, ever so far re- tional health establishment. 1 moved from our lives. Were it not for the Yet events have begun to catch up grim knowledge that 78 miners died less than four years ago in the Farmington, West Virginia explosion, or that 125 miners and their families drowned this year at Buffalo Creek, West Virginia, when a mine slag heap gave way, one might be tempted to say these stories are not only from another place, but also from another time. It all seems remi- with the occupational health establish- ment. There are new pressures from workers and the public to stop the most flagrant health and safety abuses. Within management there are some who see this pressure as a way to rationalize produc- tion. The result has been the 1970 Occu- pational Safety and Health Act which niscent of the nineteenth century Indus- has, for the first time, brought the federal trial Revolution, but certainly not like twentieth century industrial rationality, progress and enlightenment. Yet the truth of the matter is that occu- government into the business of coping with occupational hazards at most of the nation's workplaces. And the universities, medical schools and hospital centers are CONTENTS 1 Editorial 3 History and Overview 7 The Establishment 15 The Law: OSHA 20 Byssinosis 23 Letters just beginning to interest themselves in occupational medicine. The handful of present research experts and teachers will soon be joined by many more as federal, foundation and insurance com- pany money starts to sweeten the pot. The times call for an end to openly - shown bias, and for research and health care to appear objective and above the clamor of contending interest groups like man- agement and labor. The Next Step We may expect that in the next decade the present stodgy and ill prepared - occu- pational health establishment will move more toward the main focus of modern medicine and research, the medical school hospi-t afled e-r al dollar nexus. Those who stay outside will lose their credibil- ity and become irrelevant. For their part, we may expect medical, nursing and pub- lic health schools to place greater em- phasis in their curricula on occupational medicine. A few of the most glaring oc- cupational diseases will benefit from these educational reforms. It is even con- ceivable, though by no means certain, that progress in the research labs may be translated into improvement of work- place environments. On the other hand, it is inconceivable that corporation manage- ments will simply stand by and allow medical scientists to tell them how to run their businesses. Executives of big drug, hospital sup- ply, insurance and real estate companies are already well entrenched on the boards of medical schools and hospitals. From these lofty heights, these men have preserved and indeed nurtured their own business interests. As medical teaching centers move into the occupational health arena, the day will not be far off when executives from every major sector of in- dustry sit as medical school and hospital trustees. The result will be to strain these institutions'thin cloak of academic ob- jectivity, particularly if scientists press too serious an inquiry into perils on the job in the businessmen's mines, factories and farms. Ultimately, it will be business first, scientific objectivity and truth later. TEAM WORK The research for this BULLETIN was done by Health - PAC staff researchers Marsha Handelman and Desmond Callan, along with Joseph Licata, Jim Weeks and David Kotelchuck. Joseph Licata was a Health - PAC student in- tern from Antioch College. Jim Weeks was trained as an industrial engineer and now teaches in West Virginia. David Kotelchuck is a bio physicist - at Mt. Sinai Medical Center who has worked with other scientists on occu- pational health and safety issues. On September 1, David Kotelchuck became a Health - PAC staff member. Nancy Jervis, an anthropologist from Columbia University, has also joined the staff. This issue of the BULLETIN takes a brief look at the history of workplace carnage in America. We then step back to identify and examine the occupational health es- tablishment as it exists today. Next we ex- amine in detail the Occupational Safety and Health Act of 1970. We conclude this issue of the BULLETIN with a case study of cotton dust disease which shows the interaction of the issues and actors de- scribed in the previous articles. Future BULLETINS will examine work- men's compensation, the hidden role of insurance companies, and the increasing prominence of medical teaching centers. And lastly, the activities of the labor movement, workers and their medical and professional allies will be considered. Published by the Health Policy Advisory Center, 17 Murray Street, New York, N. Y. 10007. Telephone (212) 267- 8890. The Health - PAC BULLETIN is published monthly, except during the months of July and August when it is published bi monthly - . Yearly subscriptions: $ 5 students, $ 7 others. Second - class postage paid at New York, N.Y. Subscriptions, changes of address and other correspondence should be mailed to the above address. New York staff: A. Sandra Abramson, Constance Bloomfield, Des Callan, Oliver Fein, Marsha Handelman, Ronda Kotelchuck, Howard Levy and Susan Reverby. San Francisco staff: Elinor Blake, Thomas Bodenheimer, Judy Carnoy. San Francisco office: 558 Capp Street, San Francisco, California, 94110. Telephone (415) 282-3896. Associ- ates: Robb Burlage, Morgantown, West Virginia; Vicki Cooper, Chicago; Barbara Ehrenreich, John Ehrenheich, Long Island; Ruth Galanter, Los Angeles; Kenneth Kimerling, New York City. 1972. 2 HOW LONG HAVE YOU HAD THIS PROBLEM? The history of occupational health in America - the hundreds of thousands of deaths and diseases at the workplace fostered by the Industrial Revolution- is one of outrage and despair. Outrage- ous, because it was preventable; despair- ing, because it continues today, virtually unchecked and unabated. The passage of time has changed only the kind of atroc- ities practiced at the workplace. In fact, in many industries new technological de- velopments have made factories and mines more unsafe and unhealthy than ever before. Working conditions were known to be deplorable in the hazardous trades- mining, lumbering, and railroads - as long ago as the 1850's. Workers in many industries, though, did not demand safer workplaces. Much of the workforce was made up of immigrants who feared los- ing their already low paying - jobs to a surplus labor force of eager countrymen. Conditions in the " hazardous non -" in- dustries were not known to the public un- til after the turn of the century when they first appeared in the writings of muck- rakers like Upton Sinclair: " There was no heat upon the [slaugh- terhouse] beds; the men might exactly as well have worked out of doors all winter. On the killing beds you were apt to be covered with blood, and it would freeze solid; if you leaned against a pillar, you would freeze to that, and if you put your hand on the blade of your knife, you would run a chance of leaving your skin on it... The cruelest thing of all was that nearly all of them -- all of those who used knives with frost and their hands would grow numb, and then, of course, there would be accidents. Also the air would be full of steam, from the hot water and the hot blood, so that you could not see five feet in front of you; and then, with men rushing about at the speed they kept up on the killing beds, and all with butcher knives, like razors, in their hands -well, it was to be counted as a wonder that there were not more men Jungle slaugh- tered than cattle. The Jungle, 1905 Triangle Shirtwaist Fire While muckrakers stirred public inter- est in working conditions, very little gov- ernmental action was taken until 1911 when the Triangle Shirtwaist Company fire killed 146 workers, all of them women. As with many sweatshops of the day, the Greenwich Village loft where the women sewed had no ventilation, few windows, locked doors, and a fire escape which ended on the fourth floor. The disaster shook the nation and triggered a Con- gressional investigation, which resulted in the passage of safety laws and regula- tions for some industries and the appear- ance of some rudimentary safety devices on the shop floor. More important, the event contributed to the passage of work- men's compensation laws in several states. Management could no longer write off high accident rates as a fact of industrial life. But, rather than making costly changes in the production process, man- agement discovered that it could assuage workers through the bargain - priced com- pensation system. As it turned out, the compensation laws, which paid nickels and dimes for arms and legs, came just in time. The introduction of automobiles, the advent of World War I, and the dawn of the era of scientific management with its assembly lines and _ time motion - 3 studies, caused the accident rate to sky rocket. Without compensation laws, man- agement feared the workforce might strike over working conditions and stop profitable war time production. Labor Pains To lend credibility to its concern for workers, management also gave birth to an occupational health establishment. Although presenting a very different face to the public, the raison d'etre of this net- work of private, quasi private - and public organizations has been to serve manage- ment. Safety engineers represented by the American Society of Safety Engineers (begun in 1913) designed plants to create maximum production and profits without regard for the health and safety of workers. The National Safety Council (es- tablished in 1913) developed record - keep- ing systems and statistics which masked the number of injuries that occurred. The founding in 1916 of the American Associ- ation of Industrial Physicians and Sur- geons (now the Industrial Medical Asso- ciation) institutionalized the role of com- pany doctors in patching up accident victims and testifying for management in compensation cases. Inadequate as its response was, indus- 1911 " Pottstown is the center of the manu- ture of pottery, porcelain, enamel, and similar wares. Here, when the weather is murky, the smoke from hundreds of stacks settles down on the towns like a blanket. I visited some of the factories (1911) where I saw the workers dipping the wares into the lead glaze, that after firing makes china white. These men after a very few years, became so poisoned with the lead and its fumes that their teeth fall out and their joints are locked as if with the worst attacks of rheumatism. I was told that these workers did not live longer than 28-33 years old. The sacrifice of their lives was only one of the demands of capitalism. " -The Autobiography of Big Bill Harwood, 1927 4 try had at least been forced to acknowl- edge occupational injury; not so with occupationally - related disease, which was completely ignored by the compensation system. Workers were not told that they might be working with hazardous sub- stances, though some, like carbon mon- oxide and lead, had been known since antiquity to cause disease and death. Pioneering physicians like Alice Hamilton tried to make industrial diseases known to the public, as well as to persuade com- panies to change working conditions in their plants. Their efforts went largely un- noticed, except for an occasional scandal. Some physical hazards, such as noise causing deafness, are obvious. But most occupationally - induced diseases come from contact with chemicals and metals, or the inhalation of dusts. In the mid'20's the watch and clock industry employed women to paint luminous dials. Dipping their brushes in paint containing radium, the women then put the brushes to their lips to make a fine point. Years later, many died of radium poisoning, which, in the process, destroyed their teeth and jawbones and horribly disfigured their faces. The story reminded the public of a similar disaster among workers in the match industry. Alice Hamilton, who documented the disease in this country (it had been known in Europe twenty years earlier), found that it was caused by poisoning from breathing phosphorus fumes or eating from fingers smeared with the substance. Gauley Tunnel Disaster Even these scandals did not move the government into action. It took a full scale disaster, the most horrifying episode in American occupational health history, to do that. The building of the Gauley Tun- nel in Gauley Bridge, West Virginia, took the lives of hundreds and left thousands more disabled. The tunnel was built by New Kanawha Power, a subsidiary of Union Carbide, in 1930-31. " Working conditions strained credulity. Gasoline powered trains filled the tunnel with carbon monoxide, poisoning the workers and making them drowsy. But the worst hazard was the dust, silica dust, often so thick that you couldn't see ten feet in front, even with the headlight of a train. Though West Virginia laws re- quired a 30 minute wait after blasting, workers were herded back into the tunnel immediately after a blast. Foremen at times had to beat them with pick handles to get them to return. The silica content of the rock being blasted was very high. Though New Kanawha Power warned its engineers to use masks when entering the tunnel, no one ever told the workers to take precautions. Increasing numbers of workers became progressively shorter of breath and then dropped dead. The subsidiary contracted with a local undertaker to bury the blacks in a field at $ 55 per corpse. Three hours was the standard elapsed time between death and burial. In this way, the com- pany avoided formalities of an autopsy and death certificate. 170 people were turned to the compensation system, and in so doing killed three birds with one stone. Compensation was less expensive than the sums being demanded in law suits by Gauley victims and their families; it provided a way of dealing with occupa- tional disasters without the publicity that normally accompanies law suits, and, most important, it once again avoided the question of altering the production process. Nonetheless, some companies feared Suppose that one day per year, 1,800 manufacturing workers were killed and 460,000 injured enough to disable them beyond the day of the accident - no one else hurt in manufacturing the rest of the year. Suppose on another day, 1,900 workers in service occupations were killed, and 350,000 injured. On another day, 1,200 were killed in trade and 390,000 injured. We would indeed be shocked into action on any of those days. These are the National Safety Council totals for 1968. So, we have our disasters day by day, and it hurts as much as if they all come on one day, but it isn't noticed. -Paul Jennings, President International Union of Electrical Workers, 1969 OSHA hearings buried this way - two and three deep in a grave. The facts of the story didn't emerge un- til a Congressional investigation in 1935 -476 dead, 1500 disabled, according to a US Public Health Service official who testified. " -Page and O'Brien, Occupational Epidemic - Ralph Nader Task Force Report. (The Gauley disaster was graphically recorded in a 1941 novel by Hubert Skid- more, called Hawk's Nest. Union Carbide was so fearful of the bad publicity the novel would attract that it bought up every available copy of the book.) With this, industry and government at last had to respond to the existence of occupational disease. But again they they might end up paying high insurance premiums for one disease after another, and that the cost of compensation would severely limit profits. So corporations in several industries began to support med- ical epidemiological research in the work- place to determine just how dangerous particular substances were. With such " scientific " grounding, management could decide more credibly whether a disease was compensable. Consequently, only a handful of diseases - most of them dust diseases such as silicosis, black lung and asbestosis have been included in work- men's compensation. Industry Controlled Research Controlled as it is by industry, it is not surprising that industrial health research has not kept pace with all the new sub- 50 stances being introduced into industrial processes. Since World War II the number of new chemicals alone used at the work- place is a staggering 12,000. Four hun- dred chemicals are developed every year for industrial use; a new chemical introduced at the plant site every day. Few of these chemicals have been tested for toxicological effects. No matter. Work- ers are human guinea pigs who eventu- ally will provide the grim evidence. Coal miners have been coughing their lives away for 200 years. Any literature you read, whether it is Zola or anyone else who wrote about coal miners, all through the literatureruns the description of a man coughing out his life - a coal miner. How does something like that, that is so manifest and has been for hundreds of years, how does that get through with no attention? -Senator Harrison Williams 1969 OSHA hearings Such negligence is easy to overlook, because the extent and seriousness of oc- cupational disease is woefully underesti- mated. The key is accurate record - keep- ing, but industry holds that key. Occupa- tional injuries are underplayed and un- der recorded - , and occupationally - related diseases are systematically ignored, mis- diagnosed and unrecorded. But the few known and recorded statis- tics are hair raising - enough. Industry places the death rate from accidents at 14,000 a year, more than the number of men killed yearly in Vietnam; and the 6 number of workers disabled by accidents at 2.2 million. If a 1970 Bureau of Labor Statistics study estimating that 30 to 50 percent of occupational injuries and deaths go unreported is even nearly ac- curate, then 20,000 die each year and another three million are disabled. For those few industries where occupa- tional illnesses are known to exist, the statistics are equally chilling. Of 6,000 Western uranium miners, 1,100 will die in the next 20 years from lung cancer. The 200,000 workers who mine and manu- facture asbestos will die twice as fast as people of the same age in the general population. Some diseases, like black lung disease and byssinosis, which have existed for generations, have increased in severity in the last 20 years due solely to new techniques of mining coal and pro- cessing cotton. Blowing The Cover Management and its occupational health establishment have held the lid on the occupational health and safety issue for decades. Now, as the lid is lifted, more troublesome facts come to the sur- face. For example, occupational hazards may extend into future generations. Studies of pregnant operating room nurses in this country and England have shown that prolonged exposure to anesthetics is creating an alarming rate of miscarriages. And evidence is mounting that children are being exposed to toxic substances brought home in the clothes of their pa- rents. And the toll exacted by job monot- ony, speed - up and tedium are yet to be explored. The rising rates among workers of alcoholism, drug addiction and mental illness point suggestively to the work- place. If the lid on occupational injury and disease is beginning to lift generally, in Appalachia it has been blown sky high. Here miners suffering from black lung disease brought the coal industry to a halt until the government granted major con- cessions: the right to compensation for black lung and new federal safety stand- ards for mine operation. And along side the miners has grown up a new set of doctors; that have assisted by providing information and education to miners and challenging the medical criteria set by management and the government to de- termine that disease. The struggle of the Appalachian miners is hopeful, and will no doubt be followed by struggles in other industries. And workers will find themselves up against the walls of the occupational health es- tablishment. -Marsha Handelman and Joseph Licata GREASING THE CORPORATE WHEELS An occupational health establishment exists. It is almost as well hidden from the public as are the injuries and diseases with which it is supposed to deal. It is composed of private, quasi public - and governmental organizations which pur- port to offer a variety of services to in- sure workers'health: research, record- keeping, standard - setting, safety educa- tion and the administration of the multi- million dollar workmen's compensation system. It isn't any wonder that the occupa- tional health establishment takes a low public profile. Indeed, there isn't anything very public about it, despite the fact that its decisions affect the health of 34 million workers. Some groups, such as the Na- tional Safety Council and the Industrial Hygiene Foundation, were established by industry and are totally private. They are financed by industry and provide direct services to it. At a quasi public - level, the American Conference of Governmental and Industrial Hygienists and the Amer- ican National Standards Institute, both standards - setting organizations, claim to serve a broader constituency, and include some government, consumer and union representatives in their ranks. Their standards have been widely accepted as voluntary " guidelines " by industry and have recently been given the status of law. They serve basically to give an inde- pendent, professional, and somewhat pub- lic cast to what, upon closer examination, is clearly the will of private industry. With the upsurge of concern about occupa- tional health and safety and the passage of the Occupational Safety and Health Act, government has been forced into an active role. But already its independence and neutrality have been severely com- promised by its reliance on the rest of the occupational health establishment for record keeping - , initial standards and re- search. In many ways, the Occupational Safety and Health Act (OSHA) has simply brought legitimacy and govern- ment sanction to the already existing oc- cupational health establishment. Tying these organizations and manage- ment together is a common approach to the problems of occupational health and safety, consisting of first, denial of the problem; second, blaming workers for the problem; and finally, paying off workers through a workmen's compensation sys- tem designed to minimize costs to industry. Historically, management and the oc- cupational health establishment have con- centrated on workplace injuries because they are obvious, immediate and impos- sible to deny. But, in instance after in- stance, management, with the occupa- tional health establishment at its beck and call, has denied the overwhelming evidence of occupationally - related dis- ease. The Art of Denial For example, for years, coal companies, company doctors and hygienists denied the existence of black lung disease (pneu- moconeosis). To add insult to injury, miners were told coal dust was good for them. To take another example, accord- ing to mill owners, hygienists, and the U.S. Public Health Service, byssinosis or " brown lung " (see article p. 20), long recognized as a hazard in English textile. mills, did not exist in the U.S. until 1961 when an unbelieving English scientist found it to be as prevalent here as in other countries. Once again, Colgate Palmolive dismissed as " unfounded " re- ports that the production of enzyme - active detergents could cause permanent lung damage and other health problems until it was forced to concede that 141 workers in its detergent factories had reported skin and eye irritations, and 35 had res- piratory ailments. 7 When evidence of occupational disease becomes so overwhelming that it can no longer be denied, management seeks to find non occupational - causes or simply blames the worker for his or her own ill- ness. Proctor and Gamble alleges that " concentrated enzyme materials are mis- handled in production " giving rise to worker ailments. Union representatives report that the company doctor at Mon- santo Chemical in Michigan blames workers in the detergent department for the skin rashes which break out there; one worker reports that Every " time any- one goes in there with these skin prob- lems, the company doctor says,'they [] have bad hygiene habits. All I can gather Management has a com- mon approach to the problems of occupa- tional health and safety: first, denial of the problem; second, blaming workers for the problem, and finally, paying off workers through a workmen's compensation system designed to minimize costs to industry. from that is that they don't take baths.'I don't know, everyone who works there showers before he leaves the plant. " If management scientists can't blame worker's " bad habits, " other habits can be faulted. The Industrial Health Founda- tion (see below), which had made a career of finding non occupational - causes for dust induced - diseases, has tried to make the public believe that cancer in asbestos workers is caused by smoking, rather than exposure to asbestos fibers. And when workers'lifestyle arguments wear thin, the IHF has a more sophisti- cated rationalization at hand. The fault rests within workers'genes. Textile work- ers, are, they say, affected by cotton dust because they lack a certain enzyme. Workplace accidents, like disease, are blamed on worker negligence. The Na- 8 tional Safety Council (see below) claims that 75 to 85 percent of all injuries are caused by worker carelessness. DuPont's safety director does better than that. " 80 to 90 percent of all the accidents in our plants are due to worker negligence. " If worker carelessness is the problem rather than the production process, then it follows that the solution lies in safety and education campaigns to combat neg- ligence. Workers are admonished to wear hard hats, safety boots and awkward gas masks and are subjected to demeaning safety campaigns such as one recently launched by the Seagram plant in Laur- enceburg, New York. Six employees, dub- bed " The Insiders, " were authorized to perform unsafe acts deliberately - but carefully. Meanwhile, all other personnel were urged to be particularly attentive to safety violations. Those who spotted the staged violations and urged the " Insider " to be more cautious received a cash re- ward on the spot. Ironically, company safety directors don't educate workers about the effects of speedup, unsafe ma- chinery, poor ventilation and lighting, etc. Nor are workers " educated " about the na- ture of the substances they work with or the effects of the fumes or dust they breathe. Even worker education has its limits. When industry can neither deny health and safety hazards nor place the blame elsewhere, it resorts to the most econom- ical way of handling occupational injury and disease - the workmen's compensa- tion system. Workmen's compensation al- lows corporations to pay off their casual- ties at a rate which presently amounts to only one percent of payroll costs. This system, designed to deal with injury, al- lows industry to virtually ignore occupa- tional disease. With the cost of worker welfare so cheap, corporations need not make costly changes in working condi- tions or the production process which maim, mutilate and destroy the lives of workers. We now turn our attention to the occu- pational health establishment, which, throughout its short history, has served primarily to raitonalize and legitimize industry's approach to the problems of occupational health and safety. Private Groups The National Safety Council (NSC) is known to the general public by the fa- miliar refrain " 450 people will die in auto accidents this Labor Day weekend. " But NSC auto safety campaigns are vastly overshadowed by its concern with indus- trial safety, which accounts for half of its $ 10 million a year budget. Sixty percent of its board of directors are representa- The Establishment The Standard Setters AMERICAN CONFERENCE OF GOVERNMENTAL AND INDUS- TRIAL HYGIENISTS (ACGIH) is a private, professional association of government and university based hygienists, who have the major re- sponsibility for setting toxicity stand- ards in the U.S. It originated the con- cept of threshold limit values (TLVs), the level at which a substance is con- sidered safe to use in the workplace. Presently, there are 450 TLVs nation- wide. AMERICAN NATIONAL STAND- ARDS INSTITUTE (ANSI) is a pri- vate, company dominated - " consen- sus " standard setting organization. ANSI standards are the result of com- promise between industry, govern- ment, university researchers and labor - all of whom are represented on ANSI. Though it has researched only 28 toxicological substances, ANSI has been chosen by the gov- ernment as the model standard setter. The Record Keepers NATIONAL SAFETY COUNCIL INDUSTRIAL MEDICAL ASSOCIA- (NSC) is management's safety edu- cator. It offers worker education pro- grams about safety at the plant site. It is also the originator of the only form used by industry nationwide for recording industrial accidents. TION (IMA) is a private, national organization of company doctors. Its members'major function is to record industrial injuries. Because IMA members are basically accountable to management accidents are under- reported. The Researchers INDUSTRIAL HEALTH FOUNDA- TION (IHF) is industry's major re- search organization. A private group, IHF does ongoing research in several areas: occupational medicine, occu- pational nursing, law (workmen's compensation), engineering, and tox- icology chemistry - . It is involved in some standard setting research. UNIVERSITIES AND MEDICAL CENTERS. A handful of public health and medical schools have de- partments in occupational health or single researchers who have made occupational health a career. The major schools include: Pittsburgh; Harvard; Mt. Sinai Medical School; Berkeley; North Carolina. The Governmental Agencies NATIONAL INSTITUTE FOR OC- CUPATIONAL SAFETY AND OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION HEALTH (NIOSH) is part of the De- partment of HEW. NIOSH conducts research on health and safety prob- lems, but depends heavily on the ad- vice of ACGIH, IHF and the univer- sities. It is also responsible for devis- ing a national system of comprehen- sive statistics. (OSHA) is a part of the Department of Labor and was set up by the Occu- pational Safety and Health Act (1970) to be the enforcement agency for occupational health and safety. It sets fines, handles appeals on con- tested cases and trains inspectors. The Compensators THE COMMERCIAL INSURANCE INDUSTRY insures private com- panies for industrial injuries. Claims are administered through State in- dustrial accident commissions. Rates are set by the insurance industry itself through private organizations such as the National Council of Com- pensation Insurors. 0 tives from industry, insurance companies, and trade associations, and most of its budget come from contributions from these groups. In the arena of occupational safety, the NSC, founded in 1913, special- izes in record keeping - and safety edu- cation. The Council's Form Z16.1, developed in 1914, became the major national instru- ment for reporting accidents, and is the basis upon which government and indus- try statistics are derived. It is supposed to measure the frequency of disabling in- juries and industrial fatalities, and the severity of these injuries, counted in days lost. Form Z16.1 is less than a perfect tool. Indeed, its defects highlight the occupa- tional health establishment's role in down playing - hazards. As a starter, occu- pational illnesses are not even included on the form. The form permits virtual falsification of " lost time " accidents. The Council's definition of a lost time - accident is " one which so injures a worker as to prevent him or her from performing norm- ally assigned duties. " If a worker is in- jured on the job, returned the next day on a stretcher or crutches, and kept on the payroll until he is recuperated, his acci- dent is not counted as " lost time. " Peril on the Job, a study of hazards in the chemical industry, quotes a local union president in the U.S. Reduction plant in East Chicago: " We have men every now and then hobbling around here on crutches, one arm in a sling, just doing nothing, sitting in the locker room. " This charade is not without rhyme or reason, however. If lost time - accidents are too fre- quent, compensation claims rise and the company faces higher insurance rates. The passage of the Occupational Safety and Health Act has been good for the Safety Council. If a company is found violating national health and safety standards, it can demonstrate " good faith " by joining a safety organization like the National Safety Council. By so doing, a corporation can be awarded a 50 percent reduction in fines which it would otherwise receive. Whether or not OSHA insures better health for workers, it will do great things for the health of the National Safety Council. Occupational Health Practitioners: Two percent of of all registered nurses (18,000) and four percent of all doctors (8,000) make a career of occupational health. They have traditionally been rep- resented by two organizations, the Indus- trial Medical Association (IMA), founded in 1916, and the American Association of Industrial Nurses (AAIN), founded in 1942. 10 Both of the organizations are little more than fraternal lodges designed to en- hance the low esteem with which the rest of their respective professions have tradi- tionally viewed company doctors and nurses. Neither organization is a world- beater. The AAIN represents only a third of the 18,000 nurses practicing in industry, and the IMA half of the 8,000 company doctors. Neither organization sponsors re- search. Both publish journals which are not noted among medical colleagues for their scholarship or scientific excellence. Both maintain skeletal staffs and a hand- ful of do nothing - committees. But even if these organizations are of little impor- tance, the same cannot be said of the company doctors and nurses themselves. While occupational physicians and nurses have, through the years, main- tained that they are neutral parties serv- ing both management and workers, their actions clearly belie this. The AMA's " Management Guide on Occupational Health Programs " suggests that the role of occupational physicians is to: M--@ Reduce the cost of workmen's com- pensation insurance. M-- Reduce the cost of hospital and sur- gical insurance claims. M--@ Reduce absenteeism. M Reduce labor turnover. -- Increase the useful span of years of both worker and management. OE Create a good atmosphere in which the employee works. OE Persuade the employee that man- agement is sincere. OE Convince the employee that his job is important. The daily practice of company doctors The daily practice of company doctors and nurses... fulfill (s) a common goal: the reduc- tion of compensation claims and insurance premiums paid by the company. and nurses involves screening out health risks by pre employment - physicals and The Walking Wounded Gentlemen, when we lose a hand in the Fairless Works, this is not a disabling injury, when we break a leg this is not a disabling injury. When we have people literally torn apart, receiving hundreds of stitches, and laying in the dispensary for 3 days, it is not classified as a lost time accident. This is happening in industry today. - Anthony Semeraro, Safety Chairman, Fairless Steel Works, 1970 OSHA hearings Moreover, Z16.1 standard allows employers to avoid reporting many injuries by sending an injured work- er to any " regularly established job " - even if entirely different from the worker's original job. Thus employers often keep a sup- ply of unfilled low effort -, " regular " jobs just to fill with injured em- ployees. Employees are given jobs in the dispensary or the parking lot until they are recovered. Some esti- mate can be made of the magnitude of this distortion by looking at the ac- tual injury frequency within two large businesses. The results are re- vealing. For example, in December 1968, the Martin Marietta - Company had 89 " doctor cases " which were more than routine first - aid. During the same time, they reported only seven disabling injury cases under the Z16.1 standard. Records of Bethlehem Steel are similarly distored... the company's own steel plant operations'index was 13.2 whereas the frequency it reported to the National Safety Coun- cil was 0.73 per million man hours - of work. -Ralph Nader, 1969 OSHA hearings In our plant we had 2 million hours without a loss time - accident. It was not really without loss time. I won't accept the award. I won't let any- body in the local accept the award, because we had people all over the place with broken arms, elbows out of commission, and everything else. * It is all walking wounded. That is what we call it. -Steve Cadena United Steel Workers, American Can Company, 1970 OSHA hearings periodic check - ups, and reporting, or rather, under reporting - accidents and ill- nesses. Both functions fulfill a common goal: the reduction of compensation claims and insurance premiums paid by the company. The Industrial Health Foundation (IHF): Sponsored and set up by industry in 1935 as the Air Hygiene Foundation, IHF does. research on occupational health. Mem- bership is voluntary; one need only be a corporation to apply. Yearly dues, total- ing only $ 500,000, are commensurate with the size of each of its 200 member companies and trade associations. IHF does not finance its own research. Rather, member companies request a research project and pay for it themselves or solicit money for the project from the govern- ment. IHF performs some of this research itself and farms out the rest to univer- sities. Historically IHF's road has been rocky. Its first snafu was on its initial project in 1935, which sought to prove that silicosis was not an industrially - related illness. IHF made a brief comeback in the'50's when it garnered credit for curtailing steel mill pollution, which was all but destroy- ing Pittsburgh's air. But IHF's credibility was short lived -. In the'60's, it returned to its old ways, releasing a pneumoconiosis study which denied the existence of the disease altogether. Despite this history, and reports of administrative and fiscal mismanagement, IHF is still in there pitch- ing, and by and large, remains industry's research voice. Currently, IHF's two major research projects consist of byssinosis and asbes- 11 tosis, both priority diseases for the gov ernment's new research bureaucracy. These studies may be its last hope for re- demption. If IHF makes a respectable showing here (and indications are that it already has with asbestosis), it will be heavily involved in future standard - set- ting research. Quasi Public - Groups The American Council of Gov- ernmental and Industrial Hygienists (ACGIH) is a private professional asso- ciation of government and university- based hygienists. The group has 1,100 members, and is headquartered at NIOSH's Cincinatti lab where its presi- dents have traditionally worked. ACGIH sets " Threshold Limit Values, " called " TLV's, " for worker exposure to toxic sub- stances. Although ACGIH has only a skel- etal staff and no research facilities of its own, it has been the most important na- tional standard setting organization. Nevertheless the ACGIH has set only 450 TLV's for the roughly 10,000 materials in common industrial use. These stand- ards do not take into account the possible synergistic effects of exposure to several toxic materials at one time. It is striking that ACGIH standards for worker ex- posure are often set far above those which the weak kneed - Environmental Protection Agency sets for the general public. For example, workers can be ex- posed to carbon monoxide in concentra- tions of 50 parts per million, while the EPA recommends a level of 10 parts per million. The American National Standards Insti- tute (ANSI) is an association of some 900 companies, 160 trade associations, government agencies and two unions. ANSI is financed by corporate contribu- tions and dues to the tune of $ 900,000 a year. ANSI's claim to distinction is that it sets standards by " consensus " among representatives of all interested parties. When one party, such as U.S. Steel, wants a guideline for use of a toxic substance or process, it makes a request to ANSI. ANSI in turn forms a committee of all " concerned parties " (including U.S. Steel, of course). The committee sponsors and puts up the money necessary for research, and, based on this, the committee mem- bers negotiate a " consensus standard. " Given ANSI's composition and funding, it is no mystery who swings the weight behind the consensus. Historically, the standards set by ACGIH and ANSI have had a semi- official status. They have been recog- nized as guidelines for industry, were in- 12 corporated into some state federal laws like the Walsh - Healy Act in 1936 (see OSHA, p. 15), and have served as criteria in compensation cases. But they have not been enforced in industry nor has ANSI or ACGIH attempted to estab- lish an enforcement mechanism. But then, industry dominated - groups can hardly be expected to police themselves in the inter- ests of worker health. The passage of OSHA, the Occupa- tional Safety and Health Act of 1970, has for the first time, established official, po- tentially enforceable national health and safety standards covering most American workers. This is a big job for the federal government, a newcomer to the scene, so, no surprise, it turned to ANSI and the ACGIH for its initial set of standards. The effect has been to put the government stamp of approval on the work of ANSI and the ACGIH. The Federal Government The National Institute of Occupational Safety and Health (NIOSH): Until 1970 the federal government played very little role in occupational health and safety, but to the extent it had played any role, it was transparently pro industry - . The sole fed- eral agency concerned with occupational health and safety, the obscure Bureau of Occupational Safety and Health (BOSH), operated on a miniscule $ 3.3 million an- nual budget, and constantly found itself being shunted from one HEW jurisdiction to another. BOSH did some research, but had no regulatory functions. In setting re- search priorities, BOSH used to " take a survey of what industry people were thinking, " and then " applying such fac- tors as toxicity and the number of work- ers exposed, come up with its priorities, " according to Roy Fairchild, current NIOSH Lab Director. However, the growing concern about occupational safety and health which re- sulted in OSHA, made a more active and " neutral " federal role imperative, and so BOSH was superceded by a newer, spif- fier model - the National Institute of Oc- cupational Safety and Health. NIOSH's primary role is to advise the Department of Labor in the setting of national health and safety standards. In order to do this, it sets research priorities, develops re- search programs, and gathers and ana- lyzes statistics on workplace disease and injury. Grandiose as it sounds, NIOSH simply adds a new layer of obfuscation. In almost every critical role, it relies on the old occupational health establishment. For example: Recordkeeping NIOSH has respond- ed to its mandate to develop accurate oc- cupational disease, injury and death sta- POISONED PLANT The Kawecki Berylco beryllium refinery opened at Hazelton, Penn- sylvania in 1957. It was hailed as a " model " plant. The company had built a new plant in response (in part) to conditions in its old plant, which led to beryllium dust poison- ing not only of workers, but of their families as well. Though the com- pany claimed to have " learned its lesson, " reports of poor ventilation leading to respiratory problems at the new " model " plant began to trickle in. Nothing was done until 1969 when the Oil, Chemical and Atomic Work- ers Union, together with Dr. Harriet Hardy of Massachusetts General Hospital, convinced the company that an investigation was in order. Since 1965, the company doctor had been assuring workers that though there were spots on their X rays -, they were suffering from bronchitis, not berylliosis. The union study proved otherwise. Forty seven of 212 workers showed symptoms of the disease and 7 were definitely diagnosed and cautioned to stop work immediately. The beryllium exposure standard set by the American Conference of Governmental Industrial Hygienists (ACGIH) is 2 micrograms per cubic meter of air. By monitoring in remote parts of the plant, the company maintained it was within the thresh- old limit. Recently, however, the com- pany was fined 600 $ after an inspec- tion under the Occupational Safety and Health Act. Presently, the Pennsylvania Work- men's Compensation board is " reim- bursing " those workers who are completely disabled at $ 60 per week. Others receive nothing. The Kawecki Berylco tragedy, which continues today, illustrates in a microcosm how the occupational health establishment works. Com- pany doctors first denied the disease existed. Then, hygienists offered no completely safe exposure level pro- tections. Next, government investi- gated the plant, but only slapped the company's hand. Finally, the worker is left disabled, with chronic disease, but is compensated at such a poor level that he can hardly survive financially. tistics by asking the occupational health establishment groups who drew up the presently inadequate system, to draw up a new one. Re enter - the American Na- tional Standards Institute and the National Safety Council, this time in government clothing. Research priorities - NIOSH's first re- search priorities were adopted en toto from BOSH, without the benefit of consultation with workers or unions. Byssinosis didn't even make the top 90, and other sub- stances of concern to labor, such as beryl- lium, are far down on the list. NIOSH's " Target Industries -lumbering " , sheet metal and longshoring - were those with high accident rates. Occupational disease was largely ignored. Unions have asked for emergency rulings, in an attempt to force NIOSH to deal with immediate haz- ards, but NIOSH Director (and past BOSH Director) Marcus Key told a mem- ber of Ralph Nader's Task Force on Occu- pational Health, " I don't want to sit down with a bunch of guys and hear them rant and rave about the injustices suffered by workers. " Standards setting - Under OSHA, ANSI and ACGIH standards were incorporated directly into laws as " interim " standards. However, at present, NIOSH is doing re- search on only 16 standards, most of which result from emergency requests. At this rate, it will only take NIOSH 40 years to review the standards already devel- oped by ACGIH and ANSI. This will still leave 10,000 more materials to investigate, providing industry immediately ceases introducing new ones. Thus when all is said and done, the standards of the old occupational health establishment will be- come permanent U.S. standards. But this is alright, Dr. Key explains, " The burden of proof for a carcinogen rests with the producer... Rather than issuing a ban on a substance, we believe that, with proper precautions, any substance can be used in the workplace. " For all its faults, the Food and Drug Ad- ministration at least calls for some syste- matic testing of new drugs before they are marketed. Apparently workers who are exposed to new chemicals at the pro- duction end of the process don't merit such concern. A sample of what NIOSH and the Department of Labor have in store for workers may be evident in NIOSH's first standard package which dealt with asbestos. Asbestos exposure causes a lung con- dition, " asbestosis, " lung cancer, and mesothelioma, a cancer of the chest lining. 250,000 asbestos workers and 3.5 million construction workers are directly exposed 13 to the fibers. Dr. Irving Selikoff at Mt. Sinai Hospital in New York has produced dramatic evidence of the harm workers suffer from asbestos exposure. His re- search shows that asbestos workers con- tract cancer at a rate six times that of the general population. Alarmed at the inadequacy of the ACGIH's old limit of 12 fibers per cu. cm., the unions clamored for a new emergency standard of two fibers (although Seli- koff's research showed that there is no " acceptable " exposure limit whatsoever). Industry proposed a limit of ten fibers and later came down to five. Under great pressure from independent researchers, NIOSH recommended an emergency standard of five fibers, to be reduced in 1974 to two. The Labor Department over- ruled this by extending the emergency standard until 1976. While the difference between two and five fibers may not seem great, it will mean that asbestos workers will breathe an extra 20 to 30 fibers per day for two more years. But for all its frailty in terms of record- keeping, research and standard - setting, NIOSH has managed to find the where- withal to launch an entirely new area of research. Through its Behavioral and Mo- tivational Branch, NIOSH will study worker dissatisfaction and worker reac- tions to stress on the line and in the mine. ment order for research contracts. Though limited in 1971 to $ 2.5 million, 70 of the first 75 NIOSH contracts went to univer- sities. Universities, with their supposed impar- tiality, appear to be the new meeting ground for the differing occupational health interests of management and labor. Mediated by NIOSH, the United Rubber- workers and several companies are fund- ing research at Harvard and the Univer- sity of North Carolina. Under this arrange- ment, information garnered in the studies is considered the property of manage- ment. So much for impartiality. The fact is that the answer to the prob- lems of occupational health and safety are unlikely to be found either in NIOSH labs or on the university campus. Even if Nobel prize worthy research ensued, this would offer no assurance to workers that their health would be preserved. The in- vention of the best monitoring device does not insure that it will be used and the most detailed knowledge of the toxic ef- fects of chemicals does not guarantee changes in the production process which will protect workers. The real occupational safety and health work remains to be done. It is not the work of the establishment. Plant by plant, and shop by shop, investigation, educa- tion and monitoring are tasks which Q: How do you set research priorities? A: Well, you take a survey of what industry is thinking. (Our researchers) go to annual trade association meetings to find out what's on man- agement's mind. Then applying certain factors such as toxicity and number of workers exposed, you come up with your priorities. -Dr. Roy Fairchild, director NIOSH Cincinnati Laboratory Beneath NIOSH's veneer of sophistication and objectivity traces of industry's old " victim blame - the - " approach are showing. NIOSH's most important contribution may be that it is introducing a new face to the occupational health scene. For the first time, universities are competing with the older occupational health establish- 14 neither industry, the occupational health establishment nor NIOSH will assume. How workers, unions, and support groups are moving on those tasks will be the sub- ject of Health - PAC's next occupational safety and health BULLETIN. -Marsha Handelman, Joseph Licata and Jim Weeks OSHA: ACTING SAFELY On December 29, 1970, President Nixon signed into law the Occupational Safety and Health Act (OSHA), calling it " one of the most important pieces of legislation from the standpoint of the 55 million peo- ple covered by it, ever passed by the Congress of the United States. " George Meany, AFL - CIO president, hailed it as " a major victory for American workers. " A more sober appraisal shows that OSHA offers little immediate relief to the American worker. It is important, how- ever, because it has permanently changed the terrain on which occupational safety and health struggles will be waged. Prior to OSHA, occupational safety and health protection was provided mainly through workmen's compensation which was, and still is, dispensed by individual states. For those few workers who are tenacious or lucky enough to win it, com- pensation is totally inadequate. In 1970, a totally disabled worker supporting a family was paid an average of only 54 percent of his or her regular weekly wage. Compensation varies widely from state to state. In Michigan a worker who loses a hand in an industrial accident can re- ceive a total of $ 21,070, in Texas only $ 4,900 (not much money for a lifetime's loss in either case). The workmen's com- pensation system all but ignores occupa- tional diseases. In 1968, states spent an average of only 24 cents per worker for occupational health and safety. As a re- sult, fish and game wardens outnumbered state health and safety inspectors by al- most two to one (2800 to 1600), according to a recent AFL CIO - survey. Prior to OSHA, a few federal occupa- tional health and safety laws existed, but they were limited in scope. The Walsh- Healy Act of 1936 covered firms with gov- ernment contracts (about 25 percent of all U.S. workers by the 1960's). This law set health and safety standards but they went virtually unenforced. For example, Walsh - Healy inspectors issued formal complaints for only one in a thousand violations they discovered, according to recent investigations of a Ralph Nader task force. The first comprehensive federal law on occupational health and safety was pro- posed by Lyndon Johnson in 1968. Com- pared to OSHA, the proposed law was relatively tough. It gave the Secretary of Labor power to set mandatory health and safety standards and to enforce them though such administrative measures as shutting down plants in case of " imminent harm " to workers; filing court suits to en- join unsafe practices; and imposing civil and criminal penalties of up to 1,000 $ for violations of health and safety standards, with each day considered a new viola- tion. Industry, led by the U.S. Chamber of Commerce, quickly organized a national campaign to defeat the bill. However, for reasons that are not clear, organized labor did no more to support the bill than testify routinely at Congressional hearings. Meanwhile, the rest of the nation was focusing its attention on the Indochina war and on efforts to unseat the President. Under these circumstances, the Admin- istration bill didn't stand a chance. However, beneath the surface of these events, new pressures were building. Only two years later, Congress, with the sup- port of industry, passed OSHA, a watered- down version of the Johnson bill. Why the About - Face? First, after hitting an all time - low in 1958, the industrial accident rate has shot up nearly 30 percent in the last decade. Accidents mean lost money for manage- ment, both in productivity and in work- men's compensation costs. In 1964, a U.S. Public Health Service report estimated that the annual production loss due to all types of illness and injury came to a whopping 7 percent of the Gross Na- tional Product. Workmen's compensation costs have likewise sky rocketed - . From 15 1954 to 1963 alone, compensation costs soared 80 percent to a total of $ 1.6 billion. The gathering momentum of the ecol- ogy movement has also struck fear in management, fears that environmentalists may turn their attention from smokestacks and waste water emission to noxious in- plant conditions that give rise to them. Furthermore, workers have become in- creasingly aware that the long term - dangers which industrial pollution visits on the population at large, must come down even harder on those who work at its source in the factories. Thus according to a 1969 U.S. Labor Department survey, 71 percent of all workers considered occu- pational safety and health a greater con- cern than higher wages. Conferences and courses for workers on occupational health and safety, sponsored by unions such as the Oil, Chemical and Atomic Workers and health activist groups like the Med- ical Committee for Human Rights have begun to spring up across the country, with consistently enthusiastic responses from workers. Thus recent agitation on the environmental issue is coming home to roost in the workplace. The final push came in November, 1968, ironically just after the defeat of the Johnson bill, when a mine explosion in Farmington, West Virginia took the lives of 78 workers. This sparked a rank - and- file miners'movement against the neg- ligence of the owners, the laxity of the federal government, and the indifference of the corrupt United Mine Worker's lead- ership. It spurred the fight for compensa- tion of miners'black lung disease, result- ing in a major strike and passage of the federal Mine Safety Bill in 1969 (see Health - PAC BULLETIN, September, 1971). This spurred union leaders to fight harder for a comprehensive health and safety bill to protect all workers. Seeing the handwriting on the wall, industry and the Nixon administration decided to move. By 1970, industry may have had addi- tional reasons of its own for supporting a federal occupational health and safety bill. For large companies, it would avoid the crazy - quilt patchwork of state health and safety laws. It might also give large companies an advantage over their smaller competitors, many of which had no health and safety programs in the past, and cannot so easily pass on to the con- sumer the cost of bringing their plants up to federal standards. And, not incident- ally, the law will create a new and lucra- tive market for measuring and protective equipment. Already DuPont is marketing a pocket noise meter and programmed safety training courses, both developed previously for use in its own plants. 16 In the (last) 25 years... jobs, machines and equipment have claimed the lives of 400,000 Americans and disabled almost 50 million. -Karl Mantyla, 1970 United Auto Workers The Illusion of Change In 1970, after much behind - the - scenes negotiations, OSHA was passed. As could be expected, it turned out to be a hollow victory for workers. In its two cen- tral tasks, the setting of health and safety standards and their enforcement, OSHA's deficiencies became evident. (For details on the operation of the law, see box, page 17.) Standards The Secretary of Labor sets federal health and safety standards based on advice from the National Institute of Occupational Safety and Health (NIOSH). The previous discussion of NIOSH (see page 12) underscores the many weaknesses built into standard set- ting under OSHA. In summary, standards for only about 450 substances out of at least 10,000 have been set, and many of these have been adopted from previous standards set by and for industry. Re- search is proceeding at so slow a pace that it will take years to review the existing standards alone, not to mention setting new ones. And, in the last analy- sis, NIOSH's recommendations regarding standards are strictly advisory, as was clear when the Secretary of Labor over- ruled NIOSH on the asbestos standard- its first and only recommendation. Enforcement The key to enforcement of occupational safety and health stand- ards is the ability to levy stiff penalties. But penalties under OSHA are puny enough to make the whole enforcement process laughable. Minor hazards entail no punishment at all, merely notification. Penalties even for major violations are trivial. For example, the maximum fine for a serious violation is $ 1,000. The Labor Department boasts of its toughness by al- luding to a provision of the law allowing a cumulative fine of up to $ 1,000 a day, if violations are not corrected within the time period set by its inspectors. The first application of this penalty, however, oc- curred in 1972 in the case of a Philadel- phia plant which was fined, not $ 1,000, OSHA Synopsis Coverage OSHA applies to all businesses " affecting commerce " and employing one or more persons. In 1970 it covered 57 million workers in 4.1 million business establishments. Health and Safety Standards Initial OSHA standards were drawn from existing federal standards, plus " national consensus " standards, developed for industry to provide guidelines for industrial practice and state laws. Modifications of the standards and new standards are set by the Secretary of Labor. Plant Inspection Individual plants are inspected by federal inspectors, who may be accom- panied by one or more management representatives and one representative " authorized " by the employees. Inspectors can recommend that plants be cited for violations of health and safety standards, and can suggest penalties and abatement dates by which violations must be corrected. Formally, however, the Secretary of Labor issues all citations. Citations must be posted at the plant near the site of violation. Penalties The maximum penalty for violation of an OSHA health and safety standard is a fine of $ 1,000. Minor violations carry no penalties at all. The maximum penalty for willful or repeated violations is $ 10,000. If a worker is killed as a result of a willful violation, the penalty is a fine of up to 10,000 $ and a sentence of up to six months in jail. Failure to eliminate a hazard by the date set by an inspector can result in a cumulative fine of up to 1,000 $ per day. Appeals All aspects of a citation (the violation charged, penalty and abatement date) may be appealed by management to the independent, presidentially - appointed Occupational Safety and Health Review Commission. Workers can only appeal the abatement date. Review Commission decisions may be appealed to the federal courts. Also, the Secretary of Labor can grant a " variance " to permit plant operation in violation of OSHA health and safety standards. Research Research on standards is conducted by NIOSH, a branch of the U.S. Depart- ment of Health, Education and Welfare. It then makes recommendations on standards to the Secretary of Labor. Recordkeeping Employers are required to keep a log of industrial injuries and death on forms provided by the Labor Department. These must be shown to federal inspectors on demand. A general summary of injuries and deaths must be posted yearly in each plant, but workers do not have access to the more de- tailed records in the log book. No monitoring of health hazards is required, nor must records of any monitoring be kept, unless ordered for research purposes by NIOSH. State Plans States can draw up their own health and safety plans. If these are approved by the Secretary of Labor, the states can take over all enforcement powers from OSHA. Administration The Occupational Safety and Health Administration, a branch of the Labor Department created by the new law, administers most of resonsibilities of the Secretary of Labor. It hires, trains and supervises federal inspectors under OSHA, sets their inspection priorities, and conducts training courses on the law. NIOSH, the other agency created by the new law, conducts research on stand- ards and advises the Secretary of Labor, as noted above. 17 Atrocities From time to time, these vats will boil over, and as we have had oc- casion, people have been burned severely with the acids. We have one case where the maintenance man was lying under one of these huge vats, which holds 300 or 400 gallons of this boiling acid, repair- ing something under it. The company wouldn't shut the thing down and let him work under it while it was boiling. It boiled over, and fortun- ately, the company had issued safety glasses, and it preserved his eye- sight. He was able to see the skin peeling off 80 percent of his body while he lay there. It is things like this that make me sick. -Lou Laplaca, President Local 1668 UAW Englehard Chemicals and Minerals A young sprayer was found dead in the field in the tractor which had been pulling his spray - rig. He had been pouring and mixing parathion concentrate into the spray - rig tank. Parathion is the most commonly used of the highly toxic phosphate ester pesticides. The estimated fatal dose is about 9 drops orally and 32 drops dermally. In the process of mixing the concentrate, the worker contaminated his gloves inside and out. He rested his gloved hands on his trousers as he pulled the rig to apply the spray. Parathion was ab- sorbed through the skin of his hands and thighs. He began to vomit, an early symptom of parathion poison- ing. He could not remove his respira- tor and he aspirated the vomitus. The diagnosis of poisoning was con- firmed by postmortem cholinesteras tests. -Irma West, M.D. Archives of Environmental Health but $ 10 a day for 29 days for a total fine of $ 290. In fact, during the first nine months of OSHA, fines averaged only $ 22 per vio- lation - less than a parking ticket in mid- town Manhattan. This is surely a sensitive indicator of the Labor Department's lack of concern with workers'health. And if management is still edgy about the new law, it can rest easy with the knowledge that workplace inspections are 18 creeping along at a snail's pace. During the first eight months of OSHA, Labor De- partment inspectors visited only 17,743 of the 4.1 million workplaces covered by the law. At this rate, they will take 230 years to cover all workplaces. Eventually, the Labor Department expects to increase its present 400 inspectors to 2,000, according to Occupational Hazards, management's weathervane for occupational health and safety. If so, it will only take 46 years to get around to every plant. In fact, the Nixon Administration has no intention of inspecting every workplace. Nixon mouthpiece Robert Dole (Kan R. -.) recently introduced an amendment to ex- empt small businesses from OSHA. As finally passed, the legislation would re- move businesses with less than 15 em- ployees from OSHA's purview. The effect is to remove 85 percent of all U.S. busi- nesses, employing about 25 percent of all workers, from OSHA coverage. These are the very establishments which are the worst health and safety offenders, accord- ing to government studies. Luckily, the provision was killed when President Nixon vetoed the HEW appropriations bill to which it had been attached. However, the provision is certain to be reintroduced in the near future by Nixon forces. Adding Insult to Injury If OSHA's standards - setting and en- forcement mechanisms are biased in favor of management, its appeals process virtually excludes workers. For example, an employer, after being notified of a violation, can appeal the Secretary of Labor's citation, abatement date (date by which the violation must be corrected) or penalties, while workers can appeal only the abatement date. Appeals are heard by the National Occupational Safety and Health Review Commission, an independ- ent review board created by OSHA. If the Review Commission upholds an em- ployer's appeal, the violation is com- pletely thrown out. The worker, on the other hand, has no avenue to appeal the re- fusal of an inspector to issue a citation in the first place. If he feels that the inspector did a poor job didn't - visit a dangerous area in the plant or didn't take enough air samples under the law, he is helpless. The decisions of the Review Commission are not final; they can be appealed to the federal courts. Needless to say, legal ex- penses hardly give management and workers equal redress through the courts. And finally, in the unlikely event that all of these procedures go against a com- pany, it can still apply for temporary or permanent " variances, " that is, for the right to operate in violation of the law. If this weren't bad enough, OSHA con- tains provisions transferring all enforce- ment powers back to the states, the very states whose half century of inaction and indifference the new law was supposed to remedy. Already, every state has received. federal funds, covering 90 percent of its costs for developing plans to enforce health and safety standards. If the Sec- retary of Labor determines that a state plan is as good or better than OSHA in its standards and enforcement, the state will assume all federal health and safety responsibilities except standard setting. After that, the federal government will generously pay states 50 percent of their costs of implementing these plans. For the worker, this provision will no doubt mean a return to the patchwork quality and palpable injustices of the past. OSHA's bias in favor of management is seen in almost every significant provi- sion of the law. But perhaps it is seen even more clearly in what the law omits. For example, OSHA does not provide for the constant or frequent monitoring of potential health hazards in the workplace. What value is a standard, if the hazard it is to limit is not routinely checked? A single measurement, taken at the discre- tion of a federal inspector at best every year or so, is certainly no substitute. This is especially true, since, according to labor union reports, companies regularly slow down production when an inspector is in the plant. But routine monitoring of toxic substances would involve intimate regulation of day day - to - operation in the plant, and this is hardly on the agenda either of management or the federal gov- ernment. Organized labor certainly lacks the clout to enact such a measure (assum- ing that it wants to, and this is unclear). Yet this begs to be done. Without it, occu- pational health efforts become a sham. Routine monitoring raises an even more fundamental issue: Who would carry out such monitoring? Certainly not the federal government, for the task would be Herculean, and the government seems totally unprepared to cope with the min- imal commitments it now has. A logical solution would be to have monitoring done by people already in the plants. But company doctors and health and safety professionals, where present, are paid to serve the company, not make waves This leaves the task up to the workers, themselves, and they are already show- ing the necessary capability and interest to do this. But worker control, of even part of the production process is anathema to American industry. In summary, OSHA is limited in scope, lacking in enforcement and biased in favor of industry. But, for the time being, it remains one of the few options open to workers struggling around health and safety issues. OSHA acts to contain this struggle while, at the same time it ad- vances it. It binds workers in ribbons of bureaucratic red tape and moves to head off growing concern by giving the illusion of change without its substance. At the same time, it establishes certain rights which are basic to a safe and healthy workplace. The attempt to claim these rights may focus a latent anger and en- ergy that could bring important changes to the workplace. The final outcome- containment or advance- will depend on the consciousness and ingenuity both of American workers and their medical and professional allies. -David Kotelchuck WITCHES, MIDWIVES AND NURSES: A HISTORY OF WOMEN HEALERS by Deirdre English and Barbara Ehrenreich A 48 page illustrated pamphlet on how women lay healers were suppressed and how the male medical profession rose to dom- inance. A study in the origins of institutional sexism. It may be obtained for 75 from HEALTH - PAC 19 BEHIND THE COTTON CURTAIN In 1947 the U.S. Public Health Service concluded that in this country " the prob- lem of serious dust disease among cotton workers is hardly known to exist. " In this way they disposed of byssinosis, a res- piratory disease known to afflict cotton, flax and hemp mill workers on three con- tinents outside the Americas. But on January 4, 1972, cotton dust was designated by federal occupational health authorities as one of five priority indus- trial hazards. This meant that the Secre- tary of Labor will establish a new stand- ard of maximum allowable dust concen- tration in the air of textile plants, and will begin a program of enforcement under the Occupational Safety and Health Act. What happened in twenty - five years was hardly the appearance of a new disease. Rather, it was the shredding of the " cotton curtain, " a myth, long fostered by textile mill owners and doctors alike, that cotton dust disease was not a health problem in America. Similar denials have initially surrounded many other industrial diseases, such a black lung, a respiratory disease of coal miners (see BULLETIN, September, 1971). The myth around cot- ton dust was demolished, particularly in 20 the last decade, by both scientific studies and political action. The latter was under- taken by the Textile Workers Union of America (TWUA), a few sympathetic scientists, and by interested Congress- men. In fact, the essentially political pro- cess of combatting industrial disease, and of establishing priorities for occupational health research, is clearly shown in the case of byssinosis. For two centuries it has been widely known that textile workers suffered from respiratory illnesses. In earlier days these were assumed to be tuberculosis and asthma. Detailed studies on byssinosis itself have been carried out in England for the past 70 years. In the United States the first reference to byssinosis occurred in 1940 when the trade journal Textile World carried a case report on " Room Card - Fever. " Carding ( is a process of combing into straight fibres the matted cotton pad delivered from the gin to the mill.) The affected worker coughed so violently he had to quit work and filed for workmen's com- pensation. His claim was denied by the North Carolina Industrial Commission, on the grounds that he had no evidence of silicosis or asbestosis, the only dust dis- ease compensable under the law. This was no doubt true, since in all probability the worker suffered from bysinosis. Un- fortunately the compensation law in North Carolina and other Southern textile states made no mention of byssinosis then and indeed, still does not until the present day. In 1961 the " dam of ignorance " was broken. An English scientist, Dr. Richard Schilling, refused to believe the prevail- ing industrial and medical propaganda that American textile mills were too mod- ern to allow cotton dust to become a health hazard. He came here to study some American mills. His study and sev- eral since then found that American tex- tile workers have as much byssinosis as those in England and other countries. But the textile industry has long been based in isolated, patriarchal southern mill towns where scientific evidence, par- ticularly if adverse to industry, was slow to permeate. The dictatorial word of the mill owner was still the law. Even as late as 1969, Dr. Peter E. Schragg, a young pub- lic health physician, told Medical World News that the owners of several small tex- tile companies had asked him to investi- gate an outbreak of respiratory disease among mill workers. " They thought it was some sort of an infection going around. And when I told them it was byssinosis, they were no longer interested in having me continue my investigation. " As far as these mills were concerned, that ended the matter. And they were right since at that time, neither state nor federal officials had right of entry into textile mills. The Medical Picture Byssinosis is typical of many industrial diseases. The disability it causes is seri- ous and widespread. Tens of thousands are now thought to be disabled. The gen- eral public and even most doctors know almost nothing about it. Medical text- books, if they mention it at all, usually give it at most a few lines in fine print. Knowledge is scanty of the prevalence, mechanism, cause and treatment of byssinosis. It is, however, suspected that over 300, 000 of the almost one million American cotton textile workers may be exposed each year to byssinosis, also called " brown lung, " a disease caused by dust in the air of textile plants. It is particularly prevalent in those workers doing certain processes at the plants, such as carding, spinning and winding. Early symptoms are tightness in the chest, shortness of breath and cough. Oddly enough, these are at first found only on a Monday after a weekend away from work. This strange pattern, which is the critical clue to the diagnosis, is of course, exactly the reverse of that in most acute occupational dis- orders, which become worse with each consecutive day at work. With time, these symptoms become more constant and more permanent and are eventually dis- abling. No real treatment exists. The only remedy is to get away from the dust or to get rid of it. Political Action Starting in the late 1960's, pressure be- gan to mount to do something in the United States about the'disease non - ' byssinosis. Ralph Nader, in a nationwide TV special that exposed conditions in Cannon Mills'company town of Kanna- polis, N. C., called in August, 1969, for vastly expanded federal efforts to combat the disease. This was necessary, he de- clared, because the industry refused to admit the existence of byssinosis, had thwarted research efforts and had blocked effective state protective action. " The De- partment of Health, Education and Wel. fare's (HEW) programs in occupational health have been underfunded and under- led for many years, " he said. " This de- ficiency was shown clearly in the'black lung'controversy.... I urge you to avoid a repetition of this weakness in the forth- coming challenges to the cotton industry over'brown lung disease. " The Textile Workers Union of America (TWUA), the major union in the industry (although it only represents 25% of the textile workers nationally), pressed Con- gress, the Labor Department and HEW for action. Part of the campaign included heavy pressure for passage of the general Occupational Safety and Health Act, which expanded the proportion of textile plants under federal health jurisdiction from about 10 percent under the older Walsh - Healy Act to 100 percent. In December, 1969, the TWUA began to press the federal government to pro- vide workmen's compensation for byssin- osis. Hitherto compensation had been purely a state function, although passage of the 1969 Coal Mine and Safety Act created a precedent for involvement of the federal government. More recently the union campaign has focussed on a bill sponsored by Rep. Philip Burton (Calif Dem. -. ) and 90 others, to establish a federal program of benefits for textile workers suffering from byssin- osis. The Burton bill would make em- ployers pay disability pensions to dis- abled workers, now estimated in the tens of thousands, through a federal mechan- ism. This, it is felt, would spur industry to invest money it would otherwise pay in compensation, in changes in equipment and engineering practices to eliminate the threat from cotton dust. But the bill has not yet passed. The textile workers are still waiting. The Politics Of Research In May, 1969, the TWUA invited em- ployers in whose plants the union was active to join the union in sponsoring a program to find the best means to elim- inate on job - the - health hazards. They did not receive a single positive response. In November, the union approached the American Textile Manufacturers Institute (ATMI), requesting a joint study of bys- sinosis. This was turned down. An official of ATMI said that by the time they re- ceived the union's request, ATMI had ar- ranged with the Industrial Hygiene Foun- dation (IHF) in Pittsburgh to do an " independent " study of respiratory prob- lems in the textile industry. Subsequently, Gordon Hanes, President of the Hanes Corporation in Winston- Salem, N. C., remarked: " I believe Ralph Nader did us a service by calling national attention to this problem. I believe it was no coincidence that the American Textile Manufacturers Institute shortly after Mr. Nader's first blast voted 100,000 $ to en- gage the Industrial Hygiene Foundation of Pittsburgh, Pennsylvania, to make a thorough study of the problem of bys- sinosis. " ' IHF's Dr. Robert de Treville''concluded Treville''concluded " at the same time, in 1970, that byssinosis is " best described as a'symptom - complex ' 21 rather than a'disease'in the usual sense. We feel that this term may be preferable, first, in order not to unduly alarm workers as we attempt to protect their health; and secondly, to help avoid unfair designa- tion of cotton as an unduly hazardous ma- terial for use in the textile industry, rais- ing the fear that engineering control of it may be costly and that it may be better, therefore, to switch to some less costly material.... It would be unfortunate, indeed, if we were to discontinue use of cotton fibres unnecessarily, as a result of I do not believe that working for industry impairs a scientist's judgement, but it does seem to reflect on his credibility. - Irving Tabershaw, M.D. Keynote address at the 1971 Industrial Medical Association Convention not being technically sound in our discus- sion of potential hazards and controls. " On another occasion, Dr. de Treville argued: " It would be wise to delay tem- porarily the extensive and expensive changes in plant equipment and proce- dures aimed at dust suppression alone. " This advice must have pleased his sponsors, for it could provide textile mills with the excuse to withhold even longer long overdue dust control measures which would prove enormously expen- sive. In fact, an estimate by the Depart- ment of Economics of McGraw - Hill, busi- ness research and publishing firm, in June, 1971, disclosed it would cost the industry $ 110 million just to bring facil- ities up to present official pollution control standards. Representatives of " enlightened man- 22 agement " of the larger mills have moved into sponsorship of byssinosis studies, partly to show the public their concern, and partly in order to forestall less easily controlled investigations in the future. In 1969 media conscious - Burlington Mills sponsored an extensive study of byssin- osis in North Carolina, in conjunction with Duke Univerity Medical Center and the North Carolina State Board of Health. This keys in with earlier studies by the State that had remained unpublished, ac- cording to the Greensboro Daily News Record, because state physicians had been able to gain entrance to plants only on condition of not publishing their find- ings. Such limitations were overruled by the State Attorney General only in March, 1970. A frank appraisal of why Burlington undertook its byssinosis study was con- tained in America's Textile Reporter on November 13, 1969: " The sooner that the U.S. textile industry can scientifically es- tablish what many industry executives believe, that modern air conditioning and air filtration systems have made byssin- osis among textile mill employees an ex- tremely remote possibility, the sooner in- dustry will have a potent tool to prevent Congress from trying to create an elabo- rate compensation apparatus that might include an'assessment'on industry itself to finance research. " Universities Enter The Field In the last two years, byssinosis has won the status of academic concern. A turning point was the National Confer- ence on Cotton Dust and Health, held in Charlotte, North Carolina, on May 2, 1970, under the sponsorship of the Uni- versity of North Carolina, the State Board of Health, and the U.S. Department of Health, Education and Welfare. Here were assembled 200 scientists and repre- sentatives of industry, textile unions, state and federal agencies, and physi- cians in private practice. In addition to the importance of its academic setting, several significant fac- tual points emerged at the conference. " Three substantial studies in North Car- olina over the last three years of over 1,000 workers, " said one report, " show prevalence rates that are perfectly con- sistent, almost identical, with those rates that have been shown in other countries. " Furthermore, modern developments in cotton agriculture and the mill process have served to increase the cotton dust released in the textile mills, even as venti- lation improvements have labored to re- move it. Actually, since the 1960's a level of cot- ton dust in the mill atmosphere of one milligram per cubic meter of air has been recommended by the American Confer- ence of Governmental Industrial Hygien- ists (ACGIH) and accepted by the U.S. Department of Labor. As with most health standards in other industrial plants and mines, this level is not achieved in most textile plants. But regardless of the stand- ard, dust measurements are so rarely made in most textile mills, even by insurance companies and government inspectors, that enforcement in any case is minimal. One of the conferees, Dr. Arend Bou- huys, of Yale, a researcher of interna- tional stature noted for his long years of work on byssinosis, hit the nail on the head. " There is a lot that remains to be learned about [industrial lung]... dis- eases... But there is also a serious lack of application of the knowledge that we have, and we don't have to wait until all the answers are in before we can prevent people from becoming disabled. " In the case of byssinosis, mill owners may be in for a lucky technological break. Recent evidence suggests that the real culprit in byssinosis may be the dry, brit- tle leaves commonly called " bracts. " It looks as though it may be possible to dis- pose of these by such inexpensive tech- nique as washing or steaming the raw cot- ton. But even if this should materialize, the infamous history of industry denial and neglect of byssinosis stands as an archetype in the annals of occupational disease. - Desmond Callan Letters Dear Health - PAC: We would like to comment on Susan Reverby's article, " Health: Women's Work, " in the May issue. The article states that nursing has a remarkably high turnover rate, and claims that this is due to several specific problems of the woman health worker: lack of control over hours and assign- ments; low pay; the dual role of the breadwinner - mother; and the boring and repetitive nature of nurses'tasks. Al- though there is some truth in this, these problems exist for women in most job situ- ations, and they do not completely ex- plain the high turnover rate peculiar to nursing. In fact, one could take issue with many of the points. While the cost of nursing education has gone up in the last few years, it is still one of the " cheapest " pro- fessions. It is also a profession that doesn't require a college education. A nurse with a few years experience can earn between ten and twelve thousand dollars a year with many benefits: tuition refunds, health, disability and life insurance. Nurs- ing is one of the few women's professions that requires week - end and night work; this is often helpful for the working mother. The private duty or " per diem " nurse can earn between thirty and fifty dollars for an eight hours shift of her choosing. (And in New York, seventy - five dollars for a twelve hour shift.) The wide variety of specialties in nursing allows the nurse further freedom and flexibility. We would like to explore the one aspect of nursing that we feel is most responsible for the discontent and the high turnover rate. Although you touched on this aspect in your article, we do not feel that it was adequately stressed. That is: " the vast discrepancy between what nurses were trained to do and what they are allowed to do. " In nursing school, students receive intensive training in anatomy, physiology, microbiology, psychology, and sociology. We learned about the detailed medical complications of our cardiac patients, about their enzyme values, X rays -, and their emotional state. We were taught how to deal with a dying cancer patient and how to talk to the family. We learned how to teach a patient to take care of a colos- tomy or give an injection of insulin. We learned the names, side effects - and toxic effects of every medication we gave. After long and tiresome days of floor duty, we were quizzed by instructors about all as- pects of our patients'diagnosis and treat- ment. As a new graduate, I took my medical text to work every day, afraid something would come up that I might not know about. It soon became evident that all this knowledge wasn't required. My work would be evaluated on whether or not I completed all my chores on time and whether I was neat and tidy. After several jobs, I wondered if this was all there was to being a nurse, and if so, why did I go through those grueling years of school? Why was I given all this informa- tion and skill, if it was never to be used? I once reported to the intern on my ward that I had a strong suspicion that a patient was contemplating committing suicide. He ignored my suggestion and implied that I was young and overly dra- matic. I persisted and requested a psychi- atric consultation. I went to the first and 23 second year residents, to the nursing su- pervisors, and, finally, to the chief of the service. The best I got was a pat on the head. I was told: " If you're that concerned, keep an eye on her. " The more common response was: " If you want to be a psy- chiatrist, why don't you go to medical school? " Two days later, the patient jumped out of a tenth floor window, leav- ing a husband and two young children. A staff conference was held and our " failure to prevent the incident " was attri- buted to a " lack of communication. " The major frustration in nursing prac- tice, as we see it, is the nurse's categorical exclusion from any of the decision mak- ing mechanisms in patient care. We are not allowed any meaningful participation in planning patient care, other than fol- lowing orders. As a result, we think nurses lose their motivation and desire to learn. They are not called upon to contribute, they are not held accountable for their observations, and they are discouraged from exercising any judgment. Nurses go from institution to institution, not neces- sarily looking for higher pay or better working conditions, but rather searching for a place where they may have the op- portunity to use their training, exercise judgment, and to have some structured manner of contributing to patient care. To the feminist movement, the " profes- sion " of nursing represents the epitome of sexism in women's careers. It could also be considered a microcosm of a woman's role in society. If this is true, why is it that nurses have not been in the forefront of the women's movement? Most nurses have comfortably and un- questioningly assumed their subservient role. Why is it that the only national or- ganization for nurses, the American Nurses'Association, as of 1971, refused to support the Equal Rights Amendment? We thank Susan Reverby for her article on women in health; we would like to see the issues peculiar to nursing developed further. Naomi Appel, R.N. Sally Kilby Kelberg - , R.N. Dear Friends: Just a word of congratulations on the June BULLETIN discussing neighborhood health centers. The presentation was clear and positive and the problems pointed out correctly. It might have been more negative and critical thus decreasing the article's educational value. If you haven't already done so, I would advise making copies readily available to staffs of neighborhood health centers. -Judy Graham former NENA staff Dear Friends: As a nurse at NENA for two and a half years, 1 greatly appreciated your June, 1972 BULLETIN. I thought the article was objective and truthful in presenting NENA as it is. - Nancy Rajsky NENA nurse YOUR HEALTH CARE IN CRISIS a Health - PAC Special Report A 14 page, illustrated pamphlet that analyzes the forces in the health system that prevent most Americans from geting good health care. Available free of charge, upon request, for distribution at events such as health science student orientations and classes, con- sumer- community health conferences, seminars and training sessions, and health worker gatherings. Order directly from Health - PAC 24