Document qmrx1YO97aGkdpZO3GqGKE43j

9* /INTEROFFICE LAKE CHARLES TO FROM Distribution R. J. McCorquodale DATE SUBJECT June 16, 1987 Blood QAT Minutes: 6/11/87 Attendance: Murry Davis J. C. Delgado Lamar White Jon Shepherd R. J. McCorquodale ITEMS: 1. ) Monitoring Activity As soon as possible - Jon Shepherd will coordinate with Jim Rock and Lamar White to determine the specific jobs of the 42 employees identified under the current study as having abnormal enzymes. (6/26/87) Once the job identification is complete, McCorquodale will request from the lab that 10 eight hour TWA samples be obtained per job. A minimum of 5 to be "off hours" (evenings - graveyards - weekends). This activity to be complete by end of July. Data to be sent to J. C. Delgado in G.O. 2. ) Control Group To commence after beginning of Plant Communication. (Item 3). Murry Davis to coordinate with Field Supervision the determination of 100 employees to serve as a "control group" for liver enzyme study. A.) Must have never worked in Derivatives (assignment). B.) Ratio of Operations, Maintenance, Shipping and Supervision to match ratio in the original 42. C.) Questionnaire to be completed when sample drawn. J.C. & Murry to determine ratio. J.C. & Murry to draft questionnaire with input from Dr. Looney. 3. ) Communication The use of a video tape as a communication tool in attempting to relieve hourly (and salary) concerns regarding liver enzymes was accepted. Video tape to have four components: A.) Introduction - John Fike B.) Question Answer Session - McCorquodale - Looney C.) Procedure Discussion - McCorquodale D.) Labor Policy - Chuck Bellon Via brainstorming, a list of questions for Dr. Looney was prepared. McCorquodale to work up a consolidation for review by QAT. June 26th. (Original list attached) SL 4908 Distribution June 16, 1987 Page # 2 McCorquodale to arrange video-tape session once questions (and answers) are reviewed and accepted. This project has a must do priority. 4. ) Vinyl Institute Members were given a draft of questions to be posed to Vinyl Institute. Comments, revisions, etc., to be in Lamar White's hand by June 18th. Lamar to handle all VI activity. 5. ) Policy Lamar prepared a guide broken into 3 parts for the QAT to work from A.) Basis of Policy B.) Goals of New Policy C.) Elements of New Policy A.) Basis - General consensus reached in this area. McCorquodale to rewrite and distribute for review. B.) Goals - Same as A Above. C.) Elements - This item had several areas which require input and review. General agreement reached. 1.) Policy statement - McCorquodale to draft as a composite of items A & B above. 2.) Protocol - Agreement that no action or policy would be effective unless a health consideration protocol be drafted which specifically directs the plant physician in dealing with "abnormal" blood enzyme results. A meeting will be scheduled with Drs. Looney, Meyers, and Hollinger plus J. C. Delgado and as many QAT members as feasible. J. C. will draft a guideline for development of the protocol and distribute it in advance of the meeting. J. C. will also coordinate scheduling of the meeting. 3.) Once the Protocol is finalized, it will be utilized to prepare a proposal for treatment of employees relative to job assignments and other labor concerns. RJM/fb Attachments: 1. Basis of New Policy 2. Concerns With Current Policy 3. Goals of New Policy Distribution: QAT Members John Fike Chuck Bellon J . C. Delgado Dr. R. C. Looney SL 048909 Distribution June 16, 1987 Page # 3 GOALS OF NEW POLICY 1. Protect employee health. 2. Establish a consistent and equitable procedure that meets the prime goal and minimizes corporate liability. 3. Assures open communication. 4. Incorporates all monitoring results. 5. Addresses employees' economic concerns in conjunction with conservative medical objectives. SL 048910 Distribution June 16, 1987 Page # 4 BASIS OF POLICY 1. Employee health is the prime concern and objective. 2. Federal regulations will be met. 3. Corporate liability will be minimized. 4. A protocol directing action will be adhered to which assures consistent application of sound medical judgement. 5. Management will apply equitable treatment to employees based on the best medical guidelines- available. SL 0489H PROBLEMS WITH OUR CURRENT POLICY / 1. USES NON-SPECIFIC SCREENING TEST TO MAKE PASS/FAIL DECISIONS. 2. THERE HAS BEEN ESSENTIALLY NO FOLLOW-UP ON CASES WHERE SCREENING TEST INDICATED A PROBLEM. 3. DOES NOT CORRELATE PERSONNEL MONITORING HISTORY WITH / INSTANTS OF ABNORMALITY. 4. DOES NOT INSTITUTE PERSONNEL MONITORING TO DETERMINE IF EXPOSURE IS A POSSIBLE CAUSE OF ABNORMAL CASES. S%h\ S NO EVALUATION IS MADE OF NUMEROUS POSSIBLE OTHER CAUSES 0?^'^ ABNORMALITIES. 6. DOES NOT ALLOW MEDICAL JUDGEMENT, BUT INSTEAD PLAYS A' NUMBERS GAME. 7. MAKES THE MOST INCRIMINATING AND MOST COSTLY COURSE OF ^ ACTION THE FIRST CHOICE OF IN CASES OF ABNORMALITY. 8. DOES NOT ALLOW FOR THE EXPECTED VARIATION IN THE TEST RESULTS DUE TO ANALYTICAL VARIATION NOR INDIVIDUAL DIFFERENCES. 9. DOES NOT REALLY CONSIDER WORKER HEALTH AS THE PRIMARY OBJECTIVE. >10. PUTS THE CORPORATION IN THE WORST POSSIBLE SITUATION FROM A LIABILITY VIEWPOINT. 11. DOES NOT PROVIDE MEANS OF DEALING WITH REOCCURRENCES OF ABNORMALITIES. >; ^' . ' ' 12. DOES NOT^ UTILIZE A DOCTOR'S JUDGEMENT AND COLLECTION OF ALL NECESSAST FACTS TO MAKE DIAGNOSIS AND RECOMMENDATION ON CONTINUED WORK ASSIGNMENT. 13. DOES NOT PROVIDE A FAIR TREATMENT OF OUR #1 ASSET. SL 048912 QUESTIONS 1. What are we "looking" for when we draw blood? (i.e., not VCM, EDC, etc.) 2. What is an enzyme? 3. How often are blood tests done? 4. What enzymes do you look for? 5. What role do enzymes play in the body? 6. Are these enzymes normally monitored by private physicians when treating patients? 7. Who do you run these blood tests on - A, B, C, or all? 8. How do we tell when and how much exposure an employee gets? 9. Can I see my medical records and/or get a copy? 10. Why do we wait 3 weeks/3 months before retesting an employee? 11. Why do laboratories have different "normal" ranges? 12. Why does PPG use different labs? 13. Does the government know about this? 14. Have we talked with "experts" about our "problem" (concerns)? 15. Has anyone checked the validity of the lab results from the 3 different labs used (PPG, National Health, Path Lab)? 16. After years of working in Plant B - with possible liver enzyme elevations - what is going to happen to me? 17. Can a person's enzymes be caused by household cleaner, aerosols, etc., that contain C1CH. 18. Why did we start running these tests? 19. Why do we restrict people from working in Plant B? SL 048913 20. When did we begin monitoring employee's blood? 21. Has anyone at Lake Charles ever developed a disease due to organics exposure? 22. Is there any correlation between air monitoring and blood monitoring? 23. What does "exposure" mean (how can you get exposed) (breathing, ingestion, skin)? 24. What is the treatment, if any, for diseases caused by toxic chemicals? 25. Here lately, more people are being restricted from Plant B than in the past. Why, what has changed? 26. Is it effecting my health to work in Plant B? 27. What is the experience in other plants (local and PPG) - do they have this problem? 28. Some of the people that have been removed and returned to Plant B have been told to stop drinking, lose weight, and other things - they did this and cleared up. Were you able to decide if that is what caused their enzyme changes? 29. What other things besides organics in Plant B can cause these changes? 30. Why have some people been taken out of B immediately and some haven't? 31. Is there a level above the "normal" that is considered "room for analytical error" and/or do these normal ranges apply to everybody? 32. Do some people normally have slightly "elevated/abnormal" enzyme levels? 33. If I am taking medication that is suspected to cause liver effects, should I stop taking it before I am tested? 34. Where do "normal" values for enzymes come from? 35. What do elevations in enzyme levels mean? 36. What is the function of the liver? 37. What causes enzyme levels to be elevated? SL 048914 38. Do we have vinyl, EDC, etc., in our blood? 39. If I have a "high" enzyme - am I sick, i.e., cancer, AIDS, other? 40. If a person is exposed to "organics", how long does it tak to affect the liver, or show up in enzyme tests? SL 048915 This group would like to develop a "layman's" language educational presenta tion for our employees on the use of blood enzyme levels as a medical surveillance method. The five enzymes currently used are: - Alanine Aminotransferase (ALT (or) SGPT) - Alkaline Phosphatase (ALK P.) - Aspartate Aminotransferase (AST (or) SGOT) - Gamma-glutamyl transpeptidase (GGTP) - Lactate Dehydrogenase (LDH) After some preliminary discussions, we came up with seven questions we would like input on. 1. What function or role do these enzymes play in the body? (i.e., How do they work?) 2. What does the level of the enzyme(s) indicate? 3. What are the "normal" levels of these enzymes in the general population? 4. What are the possible causes for elevated enzyme levels besides excessive chemical (hepatotoxin) exposure? 5. We refer to these as "liver enzymes" - Can elevated levels indicate abnormality or problems with other organ systems? 6. If an individual has enzyme levels elevated above the "normal" range does he/she truly have a "health" problem"? 7. What is the rate of elevated enzyme levels (i.e., levels above the "normal" range) in the general population? SL 048916 -L/*&--------FuucTiQht_____Oeoesjod MjirfowAi bm&itAm 41-111 *G SHttH $ SQUARE Jill? MKi liSijii! V 8 Vinyl Bxposul /)*.ca - - - - - - - - - E- - - - - - - - 3tooo Sa*hpuc one ott ^ ; PostrwS . ReSAfilfU - 3 . b>GKS OTHER DcZAl/ITfiTlVtS XFOSV* &lood sfimpce ftoo Positive One ?ostr/HE _ *# CA<-ti/c4770*J tOOtiJC tV AREA* \-yx rhtKim Sloop rer \ , /teX-EErtteWT (Bfr I>0CTX>lt) , Approval. 'BV CMMutnffV^t, Cfl t* *3* AAefk 3 'Mount SM*tPCMi- Consuctnn/flr Putsian** (6ASYROEtJrreROL.OOtSr) /}6Re&nke*vnr r v * (e&Attr :dooc(nA) i puAwtoVe Car cotuatMhgr) --otn&l test* (BY CONSeJvnMr) * (kmoumc ZO7R4C770J -- faiY eux/rtf rmr /i 2 o*. Mote n*te*> vomunt, CdAse >&-- tv mod At* nttc* ttP4nmt ** HetAnvg f mith/m NoiufiAt. VAute + lo^ (of i ititme) 1* owe s.D. ^ T68^o 1 I I i i CONTROL C.ROU l N?ywe questionnaire 1. What is your age? ___ _ . What arA of the plan^ bo you work in? 3. What ia your job titla? 4. How much Alcohol do you consume daily?. Wee k 1 y ? ______ j. _______ 5. Are you on any madicatipn?___ __ & Hava you evar baan hospitalized? 7. What wara you hospitajlifeed for? . B. Hava you avar received a blood tranafusion? 9. If you hava racaivad p transfusion, whan did you racaiva it? 10. Hava you avar had Hepatitis? __ 11. If you had Hepatitis^ whan did you hava it? _______ ___ _____ 12. Hava you avar had any other liver diaaaaa? If o, whan? 13. Do you routinaly taka Tylenol for aches, fever, ate.? 14. Hava you aver worked ih Plant S? If *o, when? ^5. C^4^jouowor^ with any ciemieal aolvent in your job? If 16. Have you frequently taken antibiotics~for"recurring illneaaee? If so, how frequently? ___ __ t:17. Where were you employed before PP6? 10. Did you work with chem . cala whan you ware working for your previoua employer? I so, which ones? :r: 19. Do you hava any chronic illnesses? If so, what ara they? NAME___________ I, 0. NUMBER. Cl IKE TRENT I,B,L 4 I C I 41 Vfl'JA, SL 048918 Brainstorm Questions From Blood QAT Meeting - 4/23/87 Item 6 - Do we have an "abnormal" situation? 1. Do you have a health problem when you are "abnormal" per established ranges? 2. What is "normal"? 3. What time interval for retesting is appropriate to allow minor variations to return (i.e. - what is the "biological half-life" of an enzyme once present?)? 4. Are we seeing an increase in the rate of "abnormals" since 1975? 5. What is the rate of "abnormals" in the general population (non-PPG)? (a) What do "enzymes" indicate? (b) How do they work? (c) Do these 5 (SGOT, SGPT, Aik. Phosphotase, LDH & GGTP) indicate problems for organs other than the liver? (d) What are other (non-industrial related) possible causes for elevation of levels? SL 048919 PLON I. Send questionnaire to all VI member's. II. Have results compiled by VI ( or counsel >. III. Review results at next VI health, safety, and environmental committee meeting. SL 048920 QUESTIONNAIRE OSHfi 1310.1017 PART K - MEDICAL SURVEILLANCE I. APPLICATION OF REGULATIONS 1. Does your company have a policy regarding the medical surveillance requirements of 1310.1017 ? l.a. If the answer to 1 is "yes" please : -- briefly describe the policy - attach a copy of the policy i - policy is confidential 1. b. If the answer to 1 is "no" please : -- describe how your company meets the requirements of 1310.1017 2. Do you have a company doctor ? 2.a. Is the doctor full time or part-cime? 2. b. If you don't have a company doctor, please describe how your medical work is handled. 3. Would your doctor, medical personnel or tnose who Handle your medical surveillance be interested m consulting with others regarding 1019.1017 medical survei11ance. 4. Please describe how and by whom the testing reauired by 1013.1017 is done. 4. a.Please give the name of the laboratory you use, if it is outside your company. 5. Please give the name of your company doctor or other persons directly responsible for administering the medical surveillance requirements of 1013.1017. 6. Do you have other chemical production or use besides VCM or PVC ? 6.a. If the answer to 6 is "yes" , do you include the workers in any other operations under the medical surveillance requirements of 1013.1017 or do you SL 048921 I 4 have similar surveillance requirements for them ? 7. Who makes the final decision and/or recommendation on the suitability of a worker for potential exposure to VCM ? 8. Are any tests other than those described by the regulation used to make the decision on the suitability of a worker for potential exposure to VCM ? 8. a. If the answer to B is "yea", please list and/or describe the other test. 9. What are the trigger levels, on the five enzyme tests required by the regulation, at which some action is required ? 3. a. What is the action that occurs when a trigger level is exceeded ? 9. b. How were the trigger levels employed by your company determined ? 10. Has any worker at your plant ever been restricted or removed from continued potential exposure to VCM ? 10. a. If the answer to 10 is "yes", are the restrictions temporary or permanent ? 10.b. Are workers allowed to return to potential exposure to VCM if their test results return to normal ? ( or if they no longer exceed a trigger level ) 11. Please describe the method by whicn an individual is/would be/has been removed from potential ex posure. IS. Do you perform the five test required by 1019.1017 when a worker is known to have been over-exposed ( exposed in excess of the maximum levels set forth in 1019.1017 par. ) as a result of a) personnel monitoring; b) an operational upset where there was a release and a worker is "believed" to have been over-exposed ? 13. Are individual personnel air monitoring ( IPAM ) results used in any stage of your medical surveillance program ( i.e. if enzyme test results exceed a trigger level would IPAM be used to determine if the individual were having a problem with over--exposure? ) ? SL 048922 14. fire there cases where a worker nas been/would be removed immediately from potential exposure as a result of exceeding trigger levels for the enzyme test required by 1019.1017 , before the actual cause of the exceedances were determined ? 15. fire the tests required by 1019.1017 considered sufficient to determine if a worker cannot continue on a job with potential exposure to VCM ? 16. Should other follow-up testing be employed whenever test results for the five enzymes required by 1019.1017 exceed a predetermined trigger level ? II. HISTORICAL RESULTS 1. Has a worker ever been removed temporarily or permanently from potential exposure to VCM ? 2. If the answer to 1 is " yes ", a) please give the number removed temporarily; b) please give the number * that were removed permanently; c) for both types of removal please give the number that were determined to be due to work-related or exposure problems; d) please give the number that were determined to be due to non work-related causes; e> for the work related cases please indicate what the che-ical or medical cause was. 3. Have you ever had any cases where .digger levels were exceeded but the worker was not removed from potential exposure ? 3. a. If the answer to 3 is " yes ", please describe tne number arid reasons for not removing the worker ( i.e. the cause was not job related , no cause could be determined , the cause was job related but it was corrected in lieu of removing the worker ). 4. Please give the total population which has been tested and the number of years that the testing has been carried-out. 05HA 1910.1017 PART - FIXED POINT AND INDIVIDUAL PERSONNEL AIR MONITORING 1. Please describe how the alarm levels are set on your fixed point air monitoring system. 2. Please describe what action is taken, especially what respiratory measures are used when an air monitor alarm occurs. S *>>923 3. How often are individual personnel monitored ? 4. What device is used for personnel air monitoring ? 5. What action is taken if a worker experiences an over exposure ? SL 048924