Risk Management.

We have been bearing a lot about the Americans with Disabilities Act (ADA) and the new Occupational Safety and Health Administration (OSHA) regulations on Hepatitis B vaccinations. The following are some ideas on how you can manage the "risks" created by these new requirements.

Americans with Disabilities Act (ADA)

Do camp directors have to hire a person with a disability if they have a better-qualified candidate? It is unlawful to unfairly discriminate against a person with a disability if the individual is qualified for the job and the disability does not affect the "essential functions" of the position. For instance, a craft director job description may call for someone with skills in macrame, pottery, and kiln operation; the ability to communicate; and the ability to work with children. There is probably no reason accommodations could not be made for a wheelchair-bound staff member to perform these duties.

There are two factors that need to be emphasized: equal consideration must be based on the "essential functions" for the position. Second, make sure your job qualifications and requirements identify the "essential functions" of the position. (See Edie Klein's book It's My Job, available through the ACA Bookstore).

Markel Rhulen has published a Camp Director's Primer to the Americans with Disabilities Act of 1990, which clarifies most of the concerns that arise from the ADA. This publication is also available through the ACA Bookstore.

OSHA Hepatitis B Vaccinations

The original intent of the OSHA Regulation, 29 CFR 1910.1030, "Occupational Exposure to Bloodborne Pathogens," specifically included health care professionals (nurses and doctors) and ocean lifeguards as people who have primary duties that frequently expose them to blood-borne pathogens. While the environmental exposures of camp lifeguards and ocean lifeguards may be different, both have the responsibility to act immediately in case of a drowning or injury. As primary first-aid care providers, they are at the greatest risk of becoming infected, and thus are required to be immunized. There are others at camp (off-site trip leaders, security guards, and ropes course facilitators during the non-camp season) who may fall under the OSHA definition for primary care providers on a case-by-case basis.

Is it legal for the camp director to require that the Hepatitis B vaccination be a part of the job qualifications? State and local laws vary and there could be specific prohibitions against such a practice. Consult the labor department in your state for specific legal clarification.

What about vaccinations for the rest of the staff? Here the regulation is very clear. Because most staff members will render first aid as a collateral duty, the camp will not be required to offer the vaccination series upon hiring. Rather, all first-aid providers who render any first aid, regardless of direct contact with bodily fluids, must be offered the immunization series within 24 hours. Accident report forms must include the names of all the first-aid providers. It might be a good idea to revise your accident report form to indicate whether the first-aid provider has received the blood-borne pathogen training and vaccination.

All of the camp staff should have documented training on handling bio-hazards and dealing with blood-borne pathogens. There are several excellent training packages available from private companies. One good training package comes from Martin Communications, (P.O. Box 159048, Nashville, TN 37215). It includes a work book and specific forms that the staff must complete if subject to exposure.

A telephone survey of five different health care facilities identified the cost of the series (three shots over a six-month period) as ranging from $150 to $220 per person. Shop around; you may be able to cut the costs by more than half.

The vaccination is effective for up to 10 years. If the third injection is due after the employee has ended the terms of employment, the employer is not obligated to offer it. If the employee is one who is expected to return the next summer and is required to be offered the series, it would probably be to your advantage to see that the series is completed.

In most cases, your workers' compensation insurance carrier will not pay for the immunization series. You should plan your camp budget to pay for these immunizations for the required staff members and have contingency funds for accidental exposures of non-vaccinated staff. One cost control practice that might be effective is to have specific people designated as care providers. Designate vaccinated staff as "first aiders" and non-vaccinated staff as "second aiders." Unless there is a life threatening emergency, there will probably be time for a "first aider" to be quickly found.

OSHA has the authority to levy a fine for each violation of these regulations. Be aware and be prepared.