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Ht&ll OIL Mtfi.il PHDMM MOBIUSOAPE 0337 (22026M0BI) 43 MOBIL/SOAPE 0338 (22026UOBI) M OBIL O IL M l-D IO A L PROGRAM MOBIL OIL MEDICAL PROGRAM This proposal is based on the premise that occupational health services are valuable and necessary parts of any progressive and successful business venture. A medical policy (Appendix I), that citeB the general principles governing such a program, has been approved (1955) 'by Socony Mobil Oil Company's Board of Directors and is applicable to Mobil Oil Company's operations. Similarly, the Socony Mobil Oil Company's Board of Directors has established a policy of toxicology (Appendix II) which also is acceptable and applicable to the functions of Mobil Oil Company. The currently existent medical policy states that occupational health services will be available to all employees and does not distinguish among em ployees by Job, location of duties or pay status. Such services include pre placement examinations far all candidates for employment; periodic physical - examinations for all employees. Frequency of periodics logically depends on age, and/or health status, Job responsibilities, Job hazards, or legal obligations- in reference to certain types of Jobs (pilots, truck drivers, etc.). With the exception of preplacement examinations and physical examinations required by lav (I.C.C. - C.A.A. etc.) or because of hazardous operations, all other exami nations will-be on a voluntary basis. - MEDICAL PROGRAM PREPLACEMENT EXAMINATIONS Every candidate for employment with the Mobil Oil Company will be required to have a preplacement physical examination. The details and content of this type of examination are described in the Medical Department Administrative Guide (Appendix III - page 2). This requirement will apply to all candidates for employment, whether career or temporary. In certain locations (i.e. voodchoppers in Canada) it will be impossible to provide any medical agency for these examinations; thus it will be impossible to comply with this requirement. This situation would apply only rarely in Mobil Oil Company areas. As far as possible, preplacements will be done in established Mobil Oil medical facilities. If a Company medical facility is not conveniently located, such examinations will be accomplished by approved panel physicians. ' , PERIODICS In accordance with the Socony Mobil Medical Policy, all employees of the Ccopany will have the opportunity to have a periodic health review. The content of this physical examination has been described in detail in another section of this presentation (Appendix IH.-page 3). Such examinations, voluntary on the part of employee, will be offered as follows: - employees age 50 yrs. and cider . . . . . every 2 years employees age L9 yrs. and younger . . . . every 3 years MOBIL/SOAPE 0339 (22026MOBI) -2- When a new employee under age 4c years is hired, his or her first periodic physical will be arranged at the end of five years of service. This will avoid repeated examinations in a usually healthy group in which greatest labor turn over occurs. Every effort will be made to have these examinations accomplished in Company medical facilities. When done in private medical facilities, a member of the panel of physicians, with whom fair charges for such services have been established will be chosen. Occasionally, circumstances of an individual employee's health, his Job requirements, Job responsibilities, may demand more frequent medical reviews than listed above. Then more frequent or extended examinations may be indicated and recommended. Present experience with voluntary periodic? is extremely varied. Some units experience 99$ participation, sane have about 10$. Cost figures are based on 75 % participation which probably won't be reached for several years. A cost of $30 each has been assumed as a national average for examination fees, the current range of such fees is frco $15 to $55. TOXICOLOGY An active program in industrial hygiene and toxicology within the provisions of the Toxicology Policy will be implemented and actively supported. The rapidly increasing complexity of the petroleum and petro-chemical industry is multiplying the sources of possible harm to petroleum workers, consumers, the environment and to the general public. Volumes of new government regulations, planned or actual, referable to both production methods and products axe forcing new re sponsibilities and duties on the Medical Department. Assistance to all parts of the Company management must be provided in this field where new processes, in gredients or products can and will be developed in order that our Company can successfully compete in today's market. OTHER SERVICES . " Prevention of disease, accidents and disabilities will be an aim of the Company's medical effort. Every effort will be made to avoid the field of ~ curative medicine and treatment since it is not the aim or responsibility of the Company to embark in this area which can be expensive, prolonged, time consuming, and not entirely corrective. Community facilities and professional personnel should be utilized for curative services. Medical services will not be provided for dependents of employees. In addition to preplacement and periodic health inventories, Company medical staff will- carry on an uninterrupted task of health education, and counselling for employees, be available-to consult and cooperate with managements and other Company departments in any matters affecting the employee, his work environment, work assignment, work operations, or the community in which the operation is located; ' FACILITIES In implementing such a program universally throughout the Mobil Oil Company, no new in-plant installations or extensions of present in-plant operations are presently anticipated. Every effort will be made to achieve full utilization of the local medical facilities and avoid further investment in medical equipment or personnel. All presently existing Company operated facilities will be reviewed with the aim of greater, wider and more economic utilization. It is expected that among our present medical facilities seme can be dispensed with where economic utilization does not warrant their continuation. mobil/soape 0340 (22026U0BI) 46 -3- QRGANIZATION An organization designed to carry out the recommended program is shown on the attached chart (Appendix IV). A Medical Director will he appointed and will he responsihile for the entire medical program of Mobil Oil Company, the operations of the personnel assigned to that program, and will be accountable to the Employee Relations Manager of Mobil Oil Company. The Southwest Regional Medical Director located in Dallas will serve all needs for Exploration and Producing (Denver, Houston, and Midland Divisions) and Magnolia Pipeline operations. In the Magnolia Pipeline Company, he will hold the position of Medical Director. In addition to these duties, he will have medical responsibilities for the Southwest Marketing Division; the Casper Refinery; the Augusta Refinery; the Beaumont Refinery; Socony Paint Products Company operation at Beaumont; Field Research, Geophysical Labs, and'Accounting Center at Dallas; and Marine Department at Beaumont. The Regional Medical Director in the Western area located in Los Angeles will be responsible for all medical activities in the West Coast Marketing Division, the Los Angeles Exploration-Producing Division (including Alaska), the Accounting Center at Los Angeles, the Socony Paint Products Company plant at Vernon, and Socony Mobil Marine operations (west coast), as well as Torrance and Ferndale refineries. The Regional Medical Director for Mobil Oil of Canada located in Calgary will be responsible for all medical activities of that Company's operations. The Regional Medical Director located in New York will be responsible for all medical activities of the New England, Albany, Philadelphia, Detroit, Chicago, Kansas City, Twin Cities, New York City Marketing Divisions, all Manufacturing units included in these same territories with the exception of the Casper and Augusta refineries and their immediate areas. In addition, he will be responsible for medical activities (when provided in Mobil Oil Medical De partments ) of the Research and Development Department Laboratories (Paulsboro and Brooklyn), the Marine Department of Socony Mobil Oil Company and the Socony Paint Products Company at Metuchen. These four Regional Directors will report on a line basis to the Medical Director - Mobil Oil Company - located in the New York office. The four Regional Medical Directors will be responsible (within their respective regions) for " directing, implementing, staffing of the medical program as outlined and approved by management (including supervision of plant physicians, medical advisors, panel physicians and Industrial hygienists). They will be responsible for the medical services offered and be accountable for results of such services. The Regional Medical Directors shall be prepared to do or arrange for physical examinations as prescribed for preplacement or periodic examination programs, to maintain field examining services of an adequate ethical type, to do or arrange for examinations requested or required by the Company's T&PD plan, hazardous duty requirements, industrial or occupational injuries as well as . evaluate the results of same for management, to assist any Company department on MOB1L/SOAPE 0341 (22026MOBI) 47 -1- medical or health problems of individual employees or groups of employees, to arrange for facilities and materials for health education, to cooperate vith safety department on all programs to better integrate mutual aims of the safety, industrial hygiene and medical groups. They will be knowledgeable on the 6tatus of medicine, medical care, medical customs and laws, etc. in the territories for which they are held responsible, and will make every effort to achieve mutually agreeable and productive relationships with the licensed physicians and allied medical groups in the region. Within the provisions of the approved " Medical Policy and the budget authorized by management, they will operate the medical program in their region, always with due consideration of the specific - needs and viewB of local management and the Campany -as a whole. All medical records will be maintained by medical personnel under the supervision of the Regional Medical Directors. Appendix V demonstrates examples of the role played by the members of Medical Department in some of the basic features of the Company's medical program It also shows the parts that local management and local employee relations de partments play in developing and operating these features. Prior to the mergerof the affiliates, the medical program of the domestic company was extremely variable and-scattered in type, quantity and quality. It is known that not all employees receive the benefits of the existent program - more did not, than did. Under the proposed scheme, there will be available to all Mobil Oil employees, subject to the provisions of the' statement of Medical Policy, the essential . features of a uniform, modern, efficiently operated occupational health program. BENEFITS OF NEW PROGRAM To measure accurately the benefits, particularly savings, in dollars, which can be or are derived directly from an adequate industrial medical and health program is extremely difficult. There are too many variables which affect the health of employees. However, the Company has the opportunity and ability to control same of these and thus appreciably affect the health of the individual and employee group as a whole. As stated earlier, in the former organization, isolated attempts have been made to confirm specific benefits of the medical program. These efforts have been inconclusive. Under the proposed plan and with greater interest and support of many other departments within the Company, the following benefits will be sought, and more tangible proof of them should be evident. These are: ' l) reduced absenteeism 2) reduced compensation insurance costs 3) reduced and stablized sick benefit insurance costs k) better Job placement . ~ 5) quality of work force Improved 6) ultimate improvement in productivity ` 7) improvement in employee health 8) improvement in employee/union/management relations 9) lower manpower turnover mobil/soape 0342 (220260B_l^ 48 -5- 10) "better comaunity relations (public relations factors etc.) 11) reduction in number of employees retired at premature disability pensions 12) avoidance of untimely and unwarranted demands from unions on matters of medical care 13) better customer-company relationship via an active progressive program in industrial hygiene and toxicology 1*0 more healthful-safer operations and production through the hygiene and toxicology program 15) more tangible assistance to company safety program and benefits derived from such a program 16) better management of employees - employee problems with assistance of medically trained personnel 17) avoid risking of the imposition of strong federal and state control regarding employee health prc ams, environmental, sanitation and product stan 'ds. Such a universal program will cost more than the former program, but ultimately vill provide benefits which will outweigh markedly the costs. _ COMPARISON WITH PRESENT PROGRAM At the present time, it would be almost impossible to calculate the cost of medical operations in Mobil Oil Company, particularly in the area comprising the former Socony Mobil domestic operations. The establishment of a medical department activity and, if established at all, the scope of the same rested-with individual marketing division and refinery managers. A mosaic of medical plans resulted. Such a variable system was neither efficient or economical. It can be safely predicted that under a uniform system which facilitates decision making and control of cost and quality, whatever monies are spent will be better spent and more productive. At present, scene segments of Mobil Oil Company are enjoying' and utilising broad medical services, others have none at all. The rapid advances of automation, with its resultant reduction of work force, have focused more attention on the smaller work force and the individuals making up this force. Technological improvements in all industries have created greater needs for vigilance- over new processes and their effects upon employees and comnunities. With the recent bursts of enthusiasm of both the government and unions into the field of occupational health, new partners in the task of industrial health could be forced on the petroleum'industry which has always been in advance of all other industries. The present proposal should not be interpreted merely as a request for funds for a bigger program. In the past, much effort was expended in justifying whether or not a medical program should exist. Through the established Medical Policy,management has stated its desire for such a program, and under the suggested organization, the Medical Department will be obligated to answer for how extensive it will be and how effective it is. mobil/soape 0343 ... - (22026MOBI) 49 -6- Alternate courses for handling a Company medical program are available for management'8 consideration. Obviously, a decrease in the quantity of services results vith any more restricted program. This decrease in quantity of service might reflect itself in less frequent periodic examinations for the overall employee group. Another approach might be to offer the periodic program to all employees in or near a Company in-plant service, vhile limiting examinations in private medical facilities to salaried employees vho are not conveniently located to in-plant services. Under any plan, all employees hired as regular employees should be given a preplacement examination. All candidates for temporary or casual type of employment would be given a modified physical examination with a restricted amount of laboratory work (urinalysis only). However, considered medical opinion is that all candidates for employment should have a complete physical' ex^nation. The cost of this aspect of the overall program is a small but most important portion of the budget. BUDGETS AMD CONTROLS Each p^out physician (either full or part time) and each medical advisor will prepare an wnrwaai budget in advance, under the direction of the responsible Regional Medical Director. The Regional Medical Director will consolidate these budgets for the Region and submit his Regional budget to the Mobil Oil Medical Director. Mobil Oil Medical Director will assemble the overall budget and present it to the Manager Bnployee Relations for submission to the President along with the general Employee Relations budget. These budgets will include overall credits anticipated for services per- formed for the Magnolia Pipeline Company, Socony Mobil Marine Transportation and Mobil International, but will absorb all other charges resulting from services performed for Socony Mobil departments. Authorities to charge eaq>enses to the Mobil Oil Medical accounts will be delegated to Regional Medical Directors, and further by them as appropriate to plant physicians and unit medical advisors. Each person holding 6uch authority will be responsible for seeing that value is received and that budgets are not exceeded without prior clearance vith his superior. The Mobil Oil Medical Director, and the Regional Medical Directors are responsible for overall results under their, budgets. Comptrollers Department will set up accounting -procedures providing for the periodic ccorparison of actual expenses with budget, by regions nA hy units. 16 May i960 MOBIL/SOAPE -- 0344 (22026UOBI) c r\ MOBIL/SOAPE 0345 (22026M0BI) 51 SOCONY MOBIL OIL COMPANY, INC MEDICAL POLICY The Medical Policy of Socony Mobil Oil Company, Inc., is to assist management by providing programs, procedures, facilities, and specialized staff assistance essential for the attainment of the Company's objectives in relation to employee health. OBJECTIVES l. The selection of employees whose mental and physical con dition meets Company requirements. 2. The maintenance of a high level of employee health and physical fitness. 3. The proper placement of employees in positions for which they are fitted. k. Better observance by employees of the principles of health ` conservation and improvement. 5. The maintenance of healthful working conditions. -PROCEDURES 1. New Broloyees .. A prepiacement health examination shall be made and the examining physician shall report to management on the fitness of the indi vidual. 2. Health of Employees The Company will make available for all employees, without cost to them, to the extent deemed practicable by management a) medical examinations at suitable intervals by staff or Company selected physicians, b) appropriate immunizations which may be required or advisable, . c) facilities for the emergency treatment of illnesses and injuries, and . d) the advice of members of the professional medical staff in connection with personal health problems. - The Company shall not undertake extended treatment of employees' illnesses except as deemed appropriate by management or required by law. -1mobil/soape 0346 (22026MOBI) 52 SOCONY MOBIL OIL COMPANY, INC. MEDICAL POLICY . Pace 2 Special examinations shall "be required of employees subject to unusual exposure. When an employee is to be transferred to a position involving additional or changed physical requirements, examinations may he given and management shall be advised of the mental and physical fitness of the employee for the proposed position. . 3. Health Education The Medical Director shall develop and recommend to management programs of health education for employees. k. Other Activities When, in the judgment of the Company, there is a problem involving the health of employees, the Medical Department shall undertake special studies in order properly to advise_ management. RESPONSIBILITY Management will be responsible for the interpretation and applica tion of this policy. The Office of the Medical Director shall be available to management for consultation on any such matters. ' 27 October 1953 -2- (22026MOBI) MOBIL/SOAPE 0347 53 } l i i TO XICO LO G Y POLICY APPENDIX II MOBIL/SOAPE 0348 (22026M0BI) 54 Medical Department 42nd Street 8 November 1956 To: Messrs. V.A. Bellman D.H. dewell J.H. Herbert R.R. Jackson P.W. Judah W.H. Montgomery F.H. Wilcox P.S. Wise POLICY ON TOXICOLOGY Ihe petroleum industry in all its phases is becoming more complex each year. Many new chemicals and seme sources of radiation are being used, produced or marketed. New processes are being introduced and developed. One result of this expanding complexity is to multiply the sources of possible harm to petroleum workers, to consumers of petroleum products ' and to the general public. Boat this is recognized by the general public is evident from the increasing volume of inquiries concerning the toxicology of products which reach us from our own marketers, customers, and from public health officials. It is.a basic policy with many chemical and petroleum companies that new processes, ingredients or products be examined critically in the developmental stage for possible harmful biologic effects. If sufficient toxicologic and other data are not available for a pre liminary evaluation then toxicologic tests may be made. Some companies have developed their own extensive facilities for testing but most rely upon outside toxicologic testing laboratories. In our Company we have not had in the past a general policy requiring such preliminary evaluation. The attached statement of policy, dated 28 August 1956, signed by J.C. Case, has had the' approval of Directors concerned with Marketing, Manufacturing, Laboratories and Office of General Counsel. - It is suggested that this statement of policy be given sufficiently wide distribution so that those involved may keep the Medical Department informed. Ibis would include division managers, refinery managers, MOBIL/SOAPE 0349 (22026U0BI) 55 -2 laboratory directors, safety directors and others. Extra copies of the statement are available for distribution. We would appreciate having a copy of the distribution list. GMS:jd' + attachment cc: J.C. Case (3) G.S. Dunham A.T. Poster P.V. Keyser, Jr. D.R. Lamont ' C.S. Teitsworth (2) H. Willetts George M. Saunders, M.D. Medical Director mobil/soape 0350 (22026UOBI) 56 POLICY - TOXICOLOGY OF COMPANY PRODUCTS AMD PROCESSES It is an obligation of the health services in our company to as certain the nature and extent of hazards and toxicity, if any, of ingredients, company products nd processes, to employees, customers, and the general public. .It is the responsibility of the various operating departments to keep the headquarters medical department informed of new products and processes during development, or the use of materials vhich in . themselves may constitute a hazard because of their physical or chemical nature. This policy will require operating units of the comp to advise the Medical Department of such products and processes for review of possible health hazards prior to their use. In cases where the toxicology is not known or there is a reasonable doubt regarding biological effects, the Medical Department, in cooperation: with the department concerned, will recommend and initiate the necessary biologic and toxicologic tests. Information obtained in thiB manner or through the medical and scientific literature will be used, if indicated, as a basis for re- ccmnendations to the Safety Department or others regarding protection of employees, advice to the marketers concerning customer hazards, advice to others such as licensees using our processes, and for pre cautionary labeling, if required. ' - Drafting of precaution labels for Socony Mobil Products, when" necessary, will be the Joint responsibility of the Office of General' Counsel, the Socony Mobil Laboratories, the Marketing, Manufacturing and Medical Departments. 28 August 1956 /s/ J. C. Case MOBIL/SOAPE ~ 0351 J22026M0BI) ADM 1NISTKATIVE (]U I|J| APPENDIX III I \ t i ( i i (22026MOBI) 58 RECOMMENDATIONS FOR ADMINISTRATION OF THE MEDICAL POLICY MOBIL OIL COMPANY . I INTRODUCTION II PROCEDURES A. Applicable to Individual Employees and Candidates (1) Preplacetnent examinations (2) Periodic re-examinationa (3) Promotions and transfers (4) Special examinations (5) Standard immunization procedures (6) Health counselling (7) Reassignment of duties for medical reasons (8) Premature retirement for medical reasons (9) Assignment abroad (10) Transfers to new location B. Group Preventive Practices: Sanitation -- Industrial Hygiene-- Health Education C. Curative Medicine D. Health Education and Technical Training E. Investigation III PERSONNEL IV FACILITIES AND EQUIPMENT V GENERAL CONDITIONS ' *. 1 1 1 2 3 3 5 4 4 4 5 3 5 5 7 8 8 8 10 10 Appendixes I Some Jobs Which May Require Special Examinations II Potentially Hazardous Materials Encountered in Petroleum Refinery Operations . IH States That Have Incorporated Into Rules, Regulations, or Codes, Threshold Limit Values Adopted by the American Conference of Governmental Industrial Hygienists H 12 13 mobil/soape 0353 (22026UOBI) 59 I INTRODUCTION It is recommended that the policy be applied In as uniform a manner as is practical, including standards for examinations, record forms, maintenance of records and communications. However, local variations in application of the policy vill be inevitable because of the varied nature of ecopany operations which are located in many separate areas with different local health conditions, laws, and facilities far health promotion and medical care. Details for administration can be worked . out within the framework of general policy by management, medical and employee relations advisors with the advice of the Office of the Medical Director, if requested, and with due regard for local, social . and labor lavs and policies. Local policy particularly in tropical areas may require listing of specific environmental disease. Prevention of disease and disability and the attainment.of maximum use of abilities i3 the goal of modern medicine. It is cheaper to prevent than to cure, for treatment is often expensive, prolonged, time consuming, and not entirely corrective. The number of diseases which can be prevented is large and constantly '' increasing. Most infectious diseases can now be prevented or their effects minimized through group sanitary measures or personal prophylaxis:, or prompt diagnosis and proper treatment. Illnesses from exposure to - toxic fumes, mists, vapors, dusts, ionizing radiations and other substances can be avoided, usually with simple control measures. - Certain types of heart disease can be prevented; in others, the progress -- can be slowed or stopped. Some types of cancer caused by known ex ternal substances can be prevented. In many instances other cancers may be detected early and cured by relatively simple procedures. Dis orders of nutrition may be avoided or promptly corrected -by proper diet and administration of supplementary essential factors including vitamins and trace elements. Prevention of the onset or progression of disease, mental or physical, . may be achieved through measures applied to people and to the environment. II PROCEDURES .. A.' Applicable to individual employees and candidates: Personal Preventive Measures These include preplacement and periodic health inventories, health education and counselling, specific immunizations, advice concerning proper treatment of illnesses or other abnormalities, suggestions to management concerning job adjustments and others. -1- MOBIL/SOAPE 0354 (22026M0BI) 60 (l) Preplacement examinations Preplacement examinations shall be performed on all candidates for employment. They are designed to determine fitness to vork in any given Job or in a number of different Jobs. This examination is a health Inventory or base line with which com parisons can be made at subsequent examinations. The details - and extent of the examinations may vary with the Job require ments, the age and state of health of the applicant, end the - locale. It is recommended that the preplacement examinations include a careful personal health and occupational history, a family health history, a complete physical examination and certain laboratory tests. The physical examination should include the usual observations on physical measurements such as the height, weight, blood pressure, pulse rate, and the temperature, examination of skin and appendages, accessible lymph nodes, the thorax and its contents, the abdcmen, the " genitalia*, the extremities, the skeletal systems with special attention to the spine, tests of visual acuity and ' color vision, ophthalmoscopic examination, test of auditory acuity, examination of auditory canals and tympanic .membranes, testB of deep reflexes, pupillary reflexes, and ocular move ments. Digital rectal examination is advised in males. In ~ individuals 45 years of age or more, proctoscopic examination of males is reccnmended. _. The mental alertness, emotional stability and content should be assessed during the course of the examination. Clinical laboratory procedures recommended axe: a urinalysisand a hemoglobin determination by .a reliable method. If the physical examination and laboratory tests are done' in a company in-plant medical service, a chest x-ray, a serologic test for syphilis, and a test for occult blood in the feces should also be accomplished. If no in-plant service is con veniently available and a private medical examiner is utilized, a chest x-ray will not be ordered unless the candidate is unable to produce satisfactory evidence of a negative chest film taken during the preceding year. Serologic test for syphilis will not be done by a private examiner unless this service is offered free by a local municipal or state govern ment agency. Back x-rays must be advisable for certain JobB but will not' be considered as routine parts of all preplacement examinations. The findings of the preplacement examination should be recorded upon a standard form prepared by the medical department. Form CO-993 will be used for recording examinations. As a result of the preplacement examination, management is ' given the opinion of the medical examiner as to the physical' and temperamental ability of the applicant to carry out the proposed duties a nd recommendations concerning any limitation *May be omitted in women, or it may be advised. -2- MOBIL/SOAPE 0355 (22026M0BI) 61 on activities vhicb. may seem advisable. Kiis in- . formation 1b supplied on the appropriate classification form. (2) Periodic re-examinations Periodic health examinations supplemented by special ex aminations, when indicated, are reccmmended. Their purpose is to detect any deviation frcm the normal, in cipient diseases, and to give advice and counsel to employees. The frequency, type, and extent of such examinations will be recommended by the medical depart ment and will be conditioned by the previous findings, the job hazards, the age, and the responsibilities of the employees concerned. As a general rule, it is re commended that all employees be examined periodically according to the following: Employees age 50 yrs. and older - every 2 years Bmployees age 49 yrs. and younger - every 3 years If an employee is under 40 years of age at the time of ' his preplacement examination, the first periodic ex . amination will be after 5 years of employment. Subsequent periodics would be scheduled at three year intervals, until employee reaches age 50 years when examinations will be offered on every two year schedule. Employees, of any age, whose positions involve unusually heavy responsibilities and upon whose efficient per formance may depend the job security of many others (key personnel), may be examined at more frequent intervals. - The examination should include an interval health and occupational history, and physical examination. The laboratory tests will include a urinalysis, a hemoglobin determination by a reliable method, and a chest x-ray. Serologic test for syphilis need not be done at the time of each examination but .at longer .intervals or whenever Indicated. Additional tests may be required by the findings. '` The results, of periodic examinations may be recorded on the special periodic Form CO-993A or on sheet 2 of CO-993* It is not necessary to repeat the complete medical history form at each examination. (3) Promotions and transfers It is recommended that when a change in job assignment or promotion to a higher echelon is contemplated, especially when significantly different job requirements or environ mental factors are involved, the opinion of the medical ' -3- MOBWSOAPe (22026MOBI) 0356 department concerning physical fitness be sought. * Promotion or transfer examinations may be indicated, but the results of such examinations should not be released to management without permission of the employee. (4) Special examinations Special examinations may be made at suitable intervals on individuals with known or suspected mental or physical impairments, on those exposed to occupational health hazards, or working in jobs which might involve the safety of others. Bie periodicity and character of such ex aminations will be determined by the type of impairment, potential health hazard involved and by the job. Based on these examinations, appropriate recommendations will be made to management. Examples of health hazards are exposure to chromium compounds, lead compounds, benzol, analine, other organic toxic materials, ionizing radiations, and to skin irritants and to dusts. Some of the job categories where special examinations may be required are appended. (Appendix I). (5) Standard immunization procedures Standard lmnunization procedures against preventible diseases will be encouraged. 2hese may Include Immunization against smallpox, typhoid, and paratyphoid fevers, and tetanus, and in addition, depending on special circumstances, yellow fever, typhus, cholera, plague, pertussis, diphtheria, tuberculosis, influenza, polio and others. The periodicity, type, and responsible administering agent, of immunization will vary from place to place according to risk, legal requirements and local medical society practices. Ihe company may, but is not obliged to, provide any immunization procedure when epidemic conditions exist which threaten to disable so large a proportion of employees as to interfere materially with operations and against which immunization procedures can be instituted to be of optimum protection. (6) Health counselling ' ` ' Individual health counselling and advice is given during examinations by physicians and nurses and at other times as indicated. ' (7) Reassignment of duties for medical reasons When individual abnormalities are found during periodic health examinations which make it advisable to limit or change the type of work assigned an individual, appropriate recommendations will be made to management, after per mission to discuss the medical findings of the examinee is obtained in the case of periodic health examinations. (22026M0BI) -4- MOBIL/SOAPE 63 0357 (8) Premature retirement for medical reasons If it appears that an employee, because of illness can no longer continue in a productive capacity, or where his own health may be jeopardized by continuing to work, management may request examinations to determine whether premature retirement is advisable. (9) Assignment abroad On the occasion of any assignment outside the U.S.A. an employee will be given a physical examination. On return from assignment abroad, an interval history will be taken .unless the assignment exceeded six months in which case another physical examination will be accomplished. (10) Transfers to new location When an employee is transferred to a new location, his health records should be sent to the new location to be - kept there in the files of the Medical Advisor. The ' advice of the medical department Bhould be sought con ' cerolng disposition of the health records in the event a medical advisor has not been chosen. B. Group preventive practices Sanitation -- Industrial Hygiene -- Health Education (l) It should be the responsibility of a medical department to advise and assist management in maintaining a healthy working environment. This applies to actual or potential health hazards of the job as well as to such factors as conditions of lighting, ventilation,-temperature control, kitchens, cafeterias and food handling and sanitary facilities. .. (2) Food handlers should be instructed in-matters of personal hygiene and examined at intervals. (3) The detection, evaluation and recommendations far control of specific health hazards Incident to any operation is a function of the medical department and its industrial hygiene personnel, where, available, in cooperation with Safety and other departments. Such health hazards may include exposure to irritating and poisonous substances (solids, liquids, fumes, dusts, gases, mists, and smokes) which may result in acute or chronic illnesses, excessive noise, improper illumination, excessive heat, cold, or humidity, improper ventilation and exposure to ionizing ^radiations. A list of potentially toxic materials used in the petroleum industry is appended (see Appendix II). . (22026MOBI) MOBIL/SOAPE _c_ ' 0358 At the present time, most states in the U.S.A. have in corporated into rules, regulations, or codes, maxiiron permissible exposure levels (Threshold Limit Values) for hazardous chemicals. To insure compliance with statutory requirements, the handling of such materials require routine air analyses and industrial hygiene surveys to determine exposure levels and to institute corrective measures if necessary (see Appendix Hi). (4) When planning new offices, terminals, warehouses, plants, housing or other facilities, or when altering existing ones, the observations and recommendations of the medical personnel may be valuable to management. Advance planning for adequate exhaust ventilation in some work areas may forestall later, mare costly changes. The proper choice of location for a camp may eliminate the need for extensive sanitary precautions. (5) In all company operations, the appropriate me . :al per sonnel should become thoroughly familiar with work areas, job requirements, and potential or actual health hazards. The services of the New York headquarters medical department are available for consultation regarding the hazards of any operation or the toxicity of any substance. Please refer for further details to Toxicology Policy. (6) Where the company maintains housing for its employees, adequate sanitary control should be provided with the advice and reconmendation of the medical department. This applies to water supplies, mess halls, club houses, swimming pools, barber shops, commissaries, canteens, ice plants, shops, hospitals, living quarters, septic tanks, sewage disposal systems, garbage collection and disposal. This does not place operational responsibility on the medical department. ' (7) Where facilities are maintained or activities are engaged in by the company, which in the opinion of the medical department, might be dangerous to public health, the " medical department should make appropriate recommendations. (8) While communicable disease control is generally a proper function of governmental health agencies, the medical department should give'assistance to such agencies as requested and needed within the practical limits of available company personnel and facilities. (9) When governmental machinery for communicable disease control is lacking, the medical department should advise such control measures as it may consider are feasible for the protection of employees and dependents. . -6- MOBIL/SOAPE 0359 (22026M0BI) 65 (10) Group health education say be provided. Oils includes the use of such techniques as group counselling, the display of pamphlets, posters, and motion pictures, and the preparation and dissemination of articles on health topics. Die extent of such group education will be determined by local needs and by the facilities and staff available. Curative Medicine (1) This phase of health and medical activity concerns the treatment of diseases and injuries. It is not the policy to provide long term, comprehensive medical care for employees except under special circumstances. (2) Within the limits of available company personnel and facilities, the coupany may provide emergency and shortune treatment of injuries and illnesses and diagnostic rocedures. (3) The company may provide care for industrial, occupational and environmental illnesses and injuries through its own medical department or on the advice of its medical depart- ment through outside agencies. (4) General medical care, including bed care, may be provided by the company where local medical facilities and services are grossly inadequate or non-existent, or where required by law. The extent of such general medical care should be limited by the personnel and facilities of the company and should be at least equal to those required by local lavs. . (5) The company should avoid, wherever possible, the con struction, equipment, and operation of hospital facilities. Use should be made of existing private or other facilities where feasible and practical and where these are felt to be adequate by the medical department. The development of extra-company facilities should be encouraged, stimulated and supported, in all practical ways through cooperation with local health and medical groups, both private and governmental.' ' (6) When at the discretion of management the company provides medical care to individual cases beyond the limits of local company facilities, the advice of the medical department should be sought. ' (7) Where only first-time or emergency medical care is fur nished by the company, the medical department may advise and assist employees or dependents in seeking good medical care. -7- MOBIL/SOAPE 0360 (22026M08I) 66 D. Health Education and Technical Training (1) Health education of employees is fostered by the medical department through accepted techniques suitable to local customs and traditions as discussed above. (2) The company, with the advice cf the medical department', in the interests of improving its health and medical activities may provide for special training for personnel of the medical department including attendance at professional meetings. (3) Current technical literature, including periodicals and textbooks should be provided for medical department personnel. E. Investigation It may be desirable and profitable in certain areas and in connection with operations to conduct or support investigations in certain categories including: (1) The medical cause of absenteeism and accidents and the results of preventive measures in decreasing absenteeism. (2) Special studies related to certain reputed hazards of the petroleum industry including the frequency, the cause and the prevention of dermatitis and studies of the carcinogenic effects of- various petroleum de rivatives. - (3) Investigation into certain endemic diseases which may be prevalent in an area of operation and the control of which may be necessary. Malaria may be cited as an example. Ill PERSONNEL A. Where the size of an operation or health hazards warrant the provision, of medical facilities, these should be in the charge and under the direction of a duly licensed physician. B. The physician in charge should be provided with pro fessional, administrative, technical and other personnel required for the proper functioning of hi6 office. C. Physicians should be chosen for their personal qualifications as well as their professional competence and administrative ability. They should be primarily internists with a philosophy of preventive nedi'cine. They should be of sufficient caliber and stature to merit the confidence of all employees. (2202smobi) -8- MOBIL/SOAPE 0361 67 D. The number of physicians needed far an adequate health program depends upon many variable factors, including the population to be covered, the hazards involved, the labor turnover, the availability of health and medical facilities in the community and the general health level of the population concerned. Many medical authorities in the United States believe that plants vhich provide periodic health examinations, but which present few occupational hazards, require one part-time physician for 250 or fewer employees with an increasing amount of time up to one thousand employees; one full-time physician for an employee group of 1,000 to 2,500 with an additional part-time physician at about 2,000 employees and-two full-time physicians for more than 2,500 employees. A larger ratio of physicians to population is indicated where there are special Job hazards. It is the aim of sane petroleum companies to have one physician for each 1,000 refinery employees. In d tennining the amount of physicians' time needed consideration should be given to the time re quired to conduct careful medical examinations, both pre placement and periodic, to give necessary treatment, to maintain familiarity with plant operations through regularly - scheduled visits, for sanitary inspection, for planning and conducting health programs, to maintain and study records, and to make periodic reports and recommendations, lime should be allowed for attendance at professional meetings and for professional training as mentioned previously. - E. Professionally trained nurses are essential in industrial health programs in the United States. Ihe number of nurses - employed will depend upon the type of industry and the number of workers. In general, it is felt that one nurse is needed for 300 or fewer employees, two for 300 to 600, three for 1,000, and one additional nurse for each thousand em ployees up to 5,000. Additional nurses may be required because of hazards in a particular industry and to provide for shift work and for vacation periods. There should be close personal supervision of nursing activities by the physician in charge. Standing orders should be written for the direction of the nurses in the absence of the physician in charge. F. Trained laboratory technicians may be required depending ' upon the size of the program. G. Secretarial and stenographic help should be adequate to maintain records and to assist in the analysis of records and preparation of reports, H. Other personnel, including industrial hygienistb, medical administrators, biostatisticians, laboratory technicians and others may be required depending upon the size and nature of the operation. -9 (22026MOBI) mobil/soape 0362 68 IV Facilities sad. Equipment Space for housing the medical department and technical equipment and supplies should he adequate to permit efficient operation of the basic medical program. It is not possible to give a detailed description of dispensary layout or equipment needed. In general, the minimum requirements for apace should include provisions far a nurse's station and waiting room, a consultation room, an ex amination and treatment room, a toilet, and space for at least a small laboratory. V General Conditions With the approval of management, the medical department may engage suitably trained personnel and, where practical and advisable, will provide .space and facilities for a medical department in order to implement the provisions of the policy. Where desirable and possible, local medical facilities, private or otherwise, may be utilized. A qualified physician should be chosen. - Details of personal medical records and any information given in confidence by employees to members of the medical department should remain confidential and in professional channels subject to certain legal and administrative requirements concerning industrial accidents or illness, public health hazards or claims against the company or " individual members of the medical department and when certification of disability is required. When recommendations are made by medical department personnel concerning Job restrictions or limitations, the supervisor, foreman, or others directly concerned should he given the information necessary to understand the reasons for such re commendations, providing that the basic ethical and'legal principles of confidential knowledge are not violated. Medical reports, documents, case records and other data concerning health and medical activities should flow through established medical channels and should he lodged in the medical department or in the medical advisor's office, or if a medical department or medical . advisor is not yet established-, medical papers will be handled by persornel approved by the Medical Director. 16 May i960 -10- MOBIL/SOAPE MR1 (22026M0BI) 69 AEPEHDIX I SOME WORKERS MAY REQUIRE SPECIAL EXAMINATIONS Painters Diver9 Welders Lead burners Benzol handlers Aniline handlers Cable splicers Foundry vorkers Aromatic oil vorkers Metallizing or grip . blasting vorkers Tetra-ethyl lead handlers Tetra -methyl lead handlers Worker's exposed to high noise levels Residual products handlers Paraffin plant vorkers Guniting vorkers Catalyst vorkers Handlers of radio-active materials Litharge handlers Sheet lead handlers Sand blasters Pilots and co-pilots Insulation vorkers, asbestos Motor vehicle operators Overseas assignments -11- MOBIL/SOAPE 0364 (22026UOBI) APPENDIX II POTENTIALLY HAZARDOUS MATERIALS ENCOUNTERED IN PETROLEUM REFINERY OPERATIONS RESPBATCRY IRRITANTS . Asbestos Acrolein Acetaldehyde Formaldehyde Other aldehydes Dusts, physiologically inert, general Dusts, attapulgus clay Dusts, bauxite Dusts, catalyst Fluorides Furfural Lime Nitrogen oxides Ozone . Ditertiary butyl para- cresol Smoke Sulfur dioxide Welding fumes Ammonia Aluminum chloride Pine Oil ' TOXIC MATERIALS Aniline, liquid Aniline, dyes Benzol (Benzene) Cadmium Chlorinated hydrocarbons Hydrogen sulfide Cobalt, metal Lead, metal & fumes Lead, oxide, litharge Lead, tetraethyl Lead, tetrametbyl Lead, soaps Manganese Mercury Methanol . Radioactive materials, general Gamma Radiation Beta Radiation Alpha Radiation PBM (Phenyl beta naphthalamine) Silica',- free Toluol (Toluene) Xylol (Xylene) Zinc Alpha Naphtha1 Carbon Monoxide -12- (22026MOBI) --- 71 SKIN IRRITANTS Acids, general Acids, acetic Acids, hydrochloric Acids, nitric Acids, sulfuric Acids, phosphoric Benzol (Benzene) Caustics Chromium Salts Coal-tar compounds Pitch . Cobalt, metal & compounds Diethanolamine Glass wool Inhibitors Kerosine Methyl Ethyl Ketone Nickel salts Oils, general Oils, high boiling from Cat. & Steam Cracking Oils, insoluble cutting Phenol Solvents Thinners, Paint Turpentine Ultra violet radiation Wax, untreated Xylyl mercaptan Tripotas6ium phosphate Alpha naphthol Pine oil Aluminum chloride MOBIL/SOAPE mcc APPENDIX III STATES 1BAT HAVE STATUTCRY HEALTH REQUIREMENTS RELATING TO RADIATION, PRODUCT LABELING, AND EMPLOYEE VCBKING CONDITIONS State Product Health Dept. Labeling Labor Dept. Radiation Codes _____ Lavs Codes______ Codes Arkansas California Colorado Connecticut Florida Eavaii Illinois Tnd'fnnfl Kansas Kentucky Louisiana Maryland Massachusetts Minnesota Mississippi New Hampshire Nev Jersey Nev York North Dakota Ohio Oregon . Pennsylvania South Carolina South Dakota Texas Washington West Virginia Wisconsin X X X X X X X X X X X X X X X X X X X X X X XX XX X .X X X X X X X X X X X X X X X X X X X X X X X X Other states vith industrial health programs usually use the Threshold Limit Values as a guide in their vork. ' La addition to the above, a number of states have incorporated single threshold limit values into specific codes. For instance, the Nev York Department of labor lists in its code governing foundries, maximum allowable concentrations for the various dusts and fumes usually encountered, and in its code governing rock drilling, limits for silica dust. The Industrial Code Commission of Rhode Island included threshold limits for organic solvents in its code governing the manufac ture, use and storage of Industrial organic solvents in places of employment. -13- MOBIL7SOAPE 0366 (22026UOBI) 72 LU C<l o^ CO CD S CO =o oCQ 2 00 a REGIONAL .MEDICAL DIRECTOR CANADA , SOUTH-WEST1 .REGIONAL ' ' MEDICAL DIRECTOR j , o < o a u. coMIos - O zz _i << X u . H Z Ui a U0I a. Ui u > or o z vU>I .- -5 o 3? O9 L a oh b u UI s X c J < <, u LU aUI i-' X tot Ui b 2 c <Z o 5u o < UI X u. i UI UZI 5>- > O IO J < az < -ooJ OC X HO s- a .Z .Oo CL u < tt O b Vui UUI SS s w OQ ^ VI *< <u Ue Co oUI < XX UI > 5ee 5< So=< <V (22026U0BI) 73 REGIONAL ' MEDICAL DIRECTOR EASTERN 5x l* I0<->* <a. ds 1i a" UJ 0<. OCO oCoD =3 CoO m O (22026M0BI) 74 a p p e n d ix V i i (22026MOBI) 75 MOBIL/SOAPE 0369 KAIUSEH OR SUFERUrrEHDOrr e .B . ADVISOR MEDICAL AUVIUliH OR I PUKT PHYSIC1AM REOIDNAL MEDICAL 01HECTOR I 5jj II IS>*: ?j 2s swc*\sa. inBE Iss: S* *7'" kE 33 ?*8ll !&**?! Ijf*? 1SJ\ * 8..fs? -> --n w< a/ J-c_o #_aj_`aft_9_an9_--*iOe*n0^o95f--34tr f^t n ao * ---- *9< o-- a rf fpt >4a-- ft 0*i 9 : 9 9 n 9 iffe^rSfo If VC . ^ ^ E. O r 9 -- _________ __ ? |< __ g * " 'p 8 A 5* c'^'aOK^ofo ft O 9 9 9 < 9 0 -- 1 i ^H r* I H f n ft{jn -- P--O s --9 S --r t -- a 5 --9 9-- *n* ifrt *9 n D 8-o i O - 2-583 H23 8 - f ? S * ?t 2 * f* U J ft srl215 c* m p.S3 L 9s.--eft=O -- O--Oi ff S ?H. --9 AI O !*m= - ?5 3 5 5 ? 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A -- <B * --O A O _ Aft n ft 9 ^ A 99e --a a ij--rs9 9a-- . 9 9--99n9--0c*0n*--*o-- f>t nIesffnfgs--f-?r^ce ifcge-tas9 i9--af--t r9-Ongf0t >ftg0 ----if3=-A "!.s:si!5 fffn7 *5 -1 C* l S it H9--9OAO*0A9g2^*9s9*0--^Af------f3tf9-->9A*ft----f9--;9t 9----D9A----99K7--99n----9< 9ffA--9*tt S9?S--AXpft|bC"*-A p?ph 3s----9c0*8 "g 2 r fit .f--Exj--92--en--0fgtrt>nio9--------03f9nFt?rf30*f--099Sl9*ttC~-9a3f9------tf--90Ct95Sff*----9AAttC*0n90<3--tCE3--8-g99999Af0*:0>fCt9--f9ttsA93c9--?r------05t sl3 ssfal2 sfsgl^ ^%a1'sassr sS..a5 ca s s* s MEDICAL DIRECTOR MOBIL O IL INDUSTRIAL HjKSlERIST 1HPUSTRUL RTC1EIIIST DOCOWT M3BIL SATTTT ADVISOR (22026MOBI) I II o 8.aiu rs f-3 f Si* fSto*n"ffi*n~nfct ' g ***-- a" ** * x ft 1, .i0 ?s ;" n*::3.'rt :- il 5 * ft o n f:tsrZ~ ftt Aa ^s_f o > *) n * t* ft Ir* ea 7O nv 3 OtfDl <f*;JftUB0fl.fBt<( *1 * * ft c ft f3t ^-- C 5ft <-- io ft ft ft r is- -- -- c *< US -- x - o ; - o j 9 o- 9* i- Z r* D K ft ' 6i**-i5yft fr^t 5ft a fnt V: wft* 3 -- ft ft a: o b:2.3 nt < n (C(* osj ^ rr tt jM-aAffoa-cc^ftes" ? E >1*n-*eft 5 <> 3 Ift -o fr>t R*i c &c. nft ft 609 &ft9?crft-o ft <* * -ft yj Si* ft a -- o O ff ft ft O 3 " ft --f--t----- 0 X : ft 5. ft A ft ft ft & -- O ft " I --ft*A-nftOfPt^PbftSo"-fCf J*o * S*-S 38. 6 * S Pi< f5t 9 -.< fA o.looftft fat (<0 X >c o5 IP2 ill (22026M0B1) T7 5, ?* g S ."- *-Cff*-ft _ f*fttft --fftt B--ff*f--<fffft ACCB.OU ft K C O I * I cr <*3 ; m( at p . at -- ma 2 ft c n d S ? 5 V5 !. - t* C 0 T3&cp*-xr?5 3 E= 883 Si ss^nsea.? iE.,g?3 = SJFS!F^| S5ft < spnftftftcrnA **ft&5ft<-" - - ~ -- S - itssass: SCS:*^: ft ft o ^ ft 0 ft y :3f3S*-~ n ft A fft n Pv ftrftOOOBftffS glssiPzEpl-l o ao tz 5 * *< --Af5t ffttf--t9MfUtfItff(Aft*-A(-pOAAU?MOftffttO9Cofwt ftAnr*cuor*ftfto*icnMMft t ft ^-'-"""szsnifin rii ?** ?=5. p a ft ff ft C c - -- &* e *< -- ft -- ssfst; ?ftU % :r-;i*=-2;3;Sr^ft*z 0ft. J^ % S fftt ft ft "ft ft- * ft ft O O _*o liBVr S'?ii o ft ft e o -i ' ? 5 ' 3tr --n era* -- * ft ? o' -- ? s: li Is M m n i Br 8--ZZR*--%-#--*---3!i----S----2- okZsftn=&eqC:fttf*ota;frto56mfr. *="!?, E-g a3-Sft a; r O ^O -o*P1 *fIctT sfo_t_es*o TriSt MOBIUSOAPE 0371 (22026MOBI) 78 APPENDIX V I M O B IL /S O A P E 0372 ESSO STANDARD TEXACO GULF APPENDIX VI. SUMMARY OF INDUSTRY PRACTICES REGARDING PERIODIC HEALTH EXAMINATIONS ________ APRIL I960_____________ __ All employees are offered a voluntary periodic health review. In field installations, such a review is offered, regardless of age, on an annual basis. At Headquarters office (NYC), the review is offered as follows: ' 1) 50 yrs. and older - annually 2) 40-50 years - every 2 years 3) up to 10 years - every 5 years At Headquarters, all employees accepting the periodic review are seen annually (between regular assigned reviews) for interviews which include an interval medical history, chest x-ray, hemoglobin, urinalysis, height, weight, vision and blood pressure reading. If any major findings result from this simple health assessment, a full review may be ordered. Dae regular review at Headquarters or in the field consists of a history, physical examination, chest x-ray, hemoglobin, urinalysis and serology. An electrocardiogram is added in the older age group. All employees are offered a periodic health review (volun tary) based on age: annually - 45 yrs. and older every 2 years - 44' yrs. and younger If the review is done in a company installation, it consists of history, physical examination, urinalysis, hemoglobin and chest x-ray. Any other tests are done at discretion of examining physician. If review is done at outside facilities, the chest x-ray and additional tests are not done except under unusual circumstances. . At present, Gulf is planning a reorganization of their medical program.. Until now, the periodic program has been carried out in varying degrees ranging from no program to an occasional elaborate program. Port Arthur, Texas has the only in-plant service and only here is a periodic ' health examination offered to all employees. However, there is no regular periodicity since employees are seen MOBiL/SOAPE 0373 (2S026H0BI) 79 GULF (continued) -2 for periodics occasioned by: a) return fraa illness .b) occurrence of illness due to job c) compensatory injuries/illnesses d) transfers or promotions . throughout the remainder of Gulf installations, the general periodic program is carried out only for personnel in hazardous work or where required by law. Executives, however, have the authority to have their periodic by' any physician at any location. " Hie average cost of such an examination is about $154.00 per executive. Management is aware that only a small portion of their 55,000 USA employees are being examined, they hope that, under the reorganization, all employees will be examined periodically, and that there will be a better cost and quality control by centralizing the medical budget in-ihe medical department. At present, medical costs are allocated locally to each company installation and directly to the_ budget of the examinee's department. STANDARD OIL CO. OF-CALIFORNIA All employees, hourly and salaried, are given periodic examinations. These examinations are compulsory and' continued employment is contingent on complying with this regulation. -- Employees 40 yrs. to 65 yrs. - examined annualy Employees 39 yrs. and younger - examined every 2 yrs. Every effort is made to have these examinations done in a company medical department, but, in areas where none is located, panel physicians are used. The periodic examination consists of: a) a medical history - b) a physical examination c) a urinalysis Any further laboratory work indicated by the company examining physician is done at outside facilities at the employee's own expense. Such a program applies to 36,000 USA employees. - The only exceptions to the above program are 200 executives who may have additional laboratory work (EKG's - chest x-rays - GI series etc.) at company expense, if and when such is deemed necessary by the company medical department. Approximately $100 is spent per executive per year for additional work. mobil/soape 0374 (22026M0BI) 80 STANDARD OIL CO. OF CALIFORNIA (continued) STAMPARP OIL OF INDIANA -3- Presently, management is pressing for more comprehensive medical examinations for all employees. Medical management is fighting to maintain the present system. The Medical Director feels that additions to the examination of each employee might intrude on the field of private practitioners (this is a general attitude of the West Coast industrial medical organizations) and, also, he feels it would be impossible to decide where to stop with additional work (law of diminishing returns to company from the program). The entire medical program is presently being revamped, because up to this time the medical program is extremely, variable in quantity, quality, and emplo1 .s eligible for same. .. . Standard Oil of Indiana is hopeful, in their planned re organization, that all subsidiaries, including the American Oil Company at Texas City will follow one medical program. At present the Texas City Refinery operates entirely in dependently In all aspects, including medical. . At the Chicago headquarters, periodic health review is offered: every 3 years to employees under 35 every 2 years to employees 35-45 years every year to employees-45 years and above. . In their general marketing division, outside of the clerical personnel at the headquarters office at Chicago, no periodic reviews are given to employees. In local divisional head quarters areas of the marketing division, only management is eligible for periodic reviews and this is left to local management as to timing, etc. ~ In the manufacturing division, periodic health reviews are given where there are established in-plant services. Here all employees are - eligible for examined ons every three years. The executives of these manufacturing units are eligible to have an annual examination. Management presently is considering a periodic health review for all employees, regardless of function, location or pay status, to be voluntary according to age groups: 35 yrs. and younger - every 3 years 36 yrs. to 45 yrs. - every 2 years 46 yrs. and older - every year It is estimated to require years to implement such a program. mobil/soape 0375 (22026MOBI) 81 ATLAHTIC UHION CARBIDE -4- IhiB ectnpany also, like many others, is considering a re organization of its medical effort because of the variety of programs presently being followed. Presently all members of management at their headquarters offices axe examined every two years. Hie same applies to any employee in an installation where an in-plant service exists. Their marketing men are examined every 2-3 years by a traveling physician who visits all areas carrying his medical equip ment in a specially equipped automobile. Hie physician is a full time member of the company medical staff. In their producing division, only the high level people are examined and this is accomplished every two years. The remainder of their employees are not medically reviewed. In the case of all clerical employees, other than at head quarters, examinations are furnished only on request. The medical department of this company is organized into two separate divisions: 1) The medical department for headquarters, all consolidated branch offices and divisional headquarters offices. 2) The medical department which covers all manufacturing units or heavy duty type operations. . Each division has a Medical Director. The present medical program of the Headquarters and branch office divisions, will be followed in the manufacturing and heavy duty divisions. The periodic program is voluntary and is based on age groups: annually .- 45 years and older every 2 years - under 45 years There is now about a 99$ acceptance of the periodic review, which was begun in 1952. All periodic reviews include at least the history, the physical examination, complete blood count and urinalysis. In addition, any laboratory procedure deemed necessary by the examiner is accomplished. If the company medical de partment does not have the facilities or staff for the additional procedures, the cost at outside facilities is borne by the company. Further, if consultation with Eny outside specialist (psychiatrist, orthopedist, dentist, etc.) is indicated in order to give a current evaluation to the employee, these costs are borne by the company. MQSIL/SCWE (22036UOBI) UNION CARBIDE (continued) DuPONT -5- At the conclusion of each periodic, all findings are sent to the family physician of the employee, particularly if any follow-up treatment is indicated. If such periodic reviews are done in areas where no company in-plant service exists, the entire cost is absorbed by the company (the range for such is $60-4125). In the International Division of the company, all employees are seen, regardless of age, for this complete review on an annual basis. The same applies to members of the company's foreign and domestic aviation departments. This program has already been started in the heavy duty and manufacturing divisions and has covered all executive level Jobs. Within three to five years, it is hoped al1 employees of the heavy duty division will be so covered Periodic health- reviews are voluntary, according to age: under 30 years - every 2 years over 30 years - every year The periodic includes history, physical, complete blood count, urinalysis and chest film. In the orer 30 years of age group, an EKG is added. All individuals, 35 years or above, are given a chest film at the six month interval period between regular examinations. Those 50 years and older, also have a six month chest film and an interview with blood pressure reading. This plan is followed throughout all DuPont offices and plants even if an in-plant service does not exist. It is estimated that there is 97$ participation among DuPont1 s 83,000 employees lathe USA. In addition, DuPont allows and even encourages annuitants to avail themselves of the same program where DuPont main tains an in-plant service. If a field medical department needs consultation service in any specialized fields, they may request a visit of a con sultant, if such a specialist is on the staff of Head quarters Medical Office, Wilmington. Most of the specialties are represented on the staff there. In most fields, several in one specialty are on the staff thus allowing for one to be on the road almost constantly. It is thought that the entire medical program of DuPont-USA costs about $6 to $8 million. MOBIL/SOAPE 0377 (22026M0BI) 83 AMERICA!! CIANAMID . -6- A periodic health review is offered to each employee, regardless of age, each year. The program is voluntary. Most of such examinations, with about an acceptance, are done in company in-plant medical departments. The company has 11 operating divisions with a total of 25,000 employees. The reviews consist of a medical history physical examination, a hemoglobin, chest x-ray, urinalysis and any other laboratory procedure deemed necessary by the examiners. On the few examinations that cannot be done at company installations, it has been found that the average cost in outside medical facilities is about $30.00 (includes a chest x-ray). MOBlL/SOAPH 0378 (22026MOBI) 84 PERIODIC PHYSICAL EXAMINATIONS AND THE KEY PERSONNEL Introduction Ho one will doubt that the most valuable asset of a Company is its employees. A uma-ii part of the employee group bears the responsibility for directing the Company's activities and for planning and researching new fields so that the Company can succeed in today's highly competitive markets. Such individuals are the Company's key personnel. It is imperative that the health of these employees be maintained at the highest possible level. If such a goal is achieved, the Company will be assured, insofar as possible, that members of its management are not handicapped by ill health. Key personnel in wham the Company has made and is making a great investment in training and development should be provided with a comprehensive medical review as often as is deemed appropriate by the Medical Department. It is impossible to fix the frequency of the periodic examination for each member_ of this group. Each individual should have planned for him a comprehensive medical review or check-up the extent of which can only he determined by the findings of his most recent review. Neither age nor position should be or can be the determining factor. Only a thorough diagnostic evaluation of _ hiB present state of health can dictate the timing of subsequent examinations. Furthermore, it is not advisable to list the tests that make up a comprehen sive review. Key personnel will include men of all ages and each will present unique health problems. As with all other employees, a basic medical review will be made including a detailed discussion of work loads, responsibilities, a family history, a past medical history, plus a complete physical examination, urinalysis, chest x-ray and a complete blood count. Additional laboratory and x-ray tests, confirming diagnostic consultations should be ordered if indicated by the basic examination and history. Key personnel will procrastinate about, having periodic health reviews as much as any other employee. Ibey must be ' impressed that they should voluntarily avail themselves of the Company's will ingness to provide a thorough periodic examination. Most key personnel are found in the age group where many disease entities present their initial symptoms. . To apply unwarranted or duplicating tests or examinations in the laboratory, is wasteful of the examinee's time and tolerance,- as well as costly. If key personnel lose confidence in the program due to poor planning of examinations, the entire program will be jeopardized'. Nevertheless, whatever test or consultation is indicated in order to establish a medical fact or diagnosis, even if such a test is time consuming, temporarily uncomfortable or unesthetic, should be proposed and explained. In all prob ability, the sincerity and logical planning of the medical adviser will win. over any objections on the part of the examinee. If the examination is soundly planned, there will be no problem of justifying the costs of the tests.. The results, negative or positive, in the final analysis of the individual's review will give the justification. The cost of_purative treatment recommended will not be borne by the Coopany. An unexpected, but preventable death or long absence due to Berious illness mobil/soape Q379 . ( 22026M08I) R5 -2- ln the case of key personnel is both tragic, and. extremely costly to the entire Company. The goal of this section of the Mobil Oil Company's Medical Program is to assist, as much as possible, in maintaining key personnel in a "positive" state of health. This can be done directly to the advantage of the person involved, and indirectly to the advantage of all otherB in the Company. A more effective management is apx to result if managers are in good physical and mental health. Administrative Procedure The Employee Relations Department of each Company unit vill furnish to the Company physician who has custody of the medical records of the employees in that unit (Regional Medical Director, Medical Advisor, or Plant Physician) e list of key personnel. At the time of the regularly scheduled periodic, the examining physician vill be requested to make such additional tests as the Judgment of the Company physician indicates, with the objective of assuring beyond reasonable doubt that no unsuspected health problems exist. In the event health problems are discovered, special care shall be taken to impress on the employee the necessity for corrective action. A follow-up visit shall bescheduled .at the appropriate interval to verify that corrective action has been taken, or again to urge the treatment. The Company physician shall review the list of key employees with Employee Relations to determine which employees on that list should be offered more frequent periodic examinations because of the nature of their responsibility. In general, in the absence of special medical considerations, such frequency should not exceed every two years from kO-55, and every year thereafter. Annual physicals may be scheduled below age 55 in special cases where unusually heavy responsibility`and heavy work load are borne. " The ethical Doctor-Patient relationship shall be maintained. If management desires medical information about an employee, in making decisions as to assignment or promotion, for example, the employee vill be requested to authorize the physician to release the information. MOBIL/SOAPE 0380 - (22026MOBI) 86