Employee medical program: benefits beyond good health.
This article highlights our medical surveillance program, in particular occupational exposure to silica, at Lufkin Industries. In place for about two years with different levels of sophistication for various foundry operations, it covers approximately 300 of our 2000 employees. Included here are the important details necessary for program start-up, logistics and some pitfalls to avoid.
Each company will need to make its own evaluation about implementing a similar program. Our system has worked based on history, program design and, most importantly, employee involvement.
Primary melt is done by cupola (50 tons per hour, 3500 tons per month) breaking down to approximately 75% gray and 25% ductile irons. Castings can weigh up to 40,000 lb. Almost 100% captive at one time, the foundry is now about equally split between captive and jobbing work. In-house capabilities include two green sand and two nobake facilities, a pattern shop, heat treat operations, and induction and arc furnaces.
We spend approximately 10% of capital expenditures on environmental concerns to provide a safer and more healthy work environment. We continually assess program effectiveness. Employee Environment
Employee exposures to spray paint and primers can be complex especially when located adjacent to the cleaning areas. This area is continually tested using industrial hygiene programs designed to improve methodology.
Most employees want to be involved in these testing procedures. It is sometimes difficult to hang samplers and pumps on people, but it is not unusual to have some employees requesting to wear two or three pumps simultaneously.
Table 1 shows a portion of a recent data sheet from one of our industrial hygiene sampling efforts. It is important to understand that we have exposure cases and the potential for future exposures.
The left column lists the exposure concentration for silica as compared to the OSHA permissible exposure limit (PEL). In a few cases, the PEL is exceeded by as much as five times.
Health Testing Program
It was a company decision to investigate and expand our health testing programs as well as some existing practices not unlike those at your plants.
The first existing practice was pre-placement physicals that have been done for many years and included X-ray and pulmonary function testing. Some physicals were done at the employees' request. If employees had a health concern about their exposure, their requests were always approved. Inhouse biological monitoring (exposure to lead) and audiometric testing for noise exposure have been done for years. Medical surveillance for silica exposure was lacking and this was an area to improve. Most of the X-rays and pulmonary function studies were done, primarily for preplacement purposes.
Our decision to improve the programs was backed by our company commitment to establish a program that would qualify the effectiveness of our industrial hygiene programs. Though we had sound ventilation and respirator training programs in place, we had no way to qualify their effectiveness.
Second, we wanted to identify any existing occupational disease or illness. At this point, the company was apprehensive about the program assessment, but it made a commitment at the outset to deal with whatever results were found.
The third reason was to protect employees with positive findings. These positive findings don't necessarily have to be occupational. Most states probably have liberal Worker's Compensation systems, and if we aggravate a preexisting condition by as much as 1%, we may find ourselves liable for the total problem. Offering a program that would allow us to medically remove employees with positive findings, regardless of whose fault it was, offered a two-fold benefit. The employee and the company both benefit.
The final reason was to provide early indications to prevent the manifestation of disease, since occupational exposures for the most part are dose related. Early involvement, we found, can prevent certain problems.
Developing the Program
Other testing is under way for occupational diseases. Some labor organizations and trial lawyer groups are providing some occupational testing, and it was important for us to check into these programs.
We felt we could diminish litigation by dealing with knowns rather than unknowns. As you may know, the first notice of a problem is usually from an attorney. A sound program for employee health testing and workplace hazards will put you in a much improved legal position.
The health and safety awareness of our employees is high because of the media attention focused on the subjects. We've raised that level of consciousness through our employee right-to-know and hazard communication programs. The employees were asked questions about workers' health and occupational exposures that weren't asked a decade ago.
We wanted to be able to provide medical clearance for respirator use for operations where employees are required to wear respirators. It has been mandated that employees are granted medical clearance. We have had varying degrees of success in that area and, when investigating a program, we wanted to ensure this was included.
Since we wanted to remain in the mainstream of occupational health services for foundry workers, we investigated a number of published resources. These resources offer some items of importance:
* A 1984 document by the U.S. Department
of Health and Human Services,
"The Selection of Patients for X-Ray
Examinations; Chest X-Ray Screening
Examinations." X-raying is a concern,
as far as when to perform the
exam and when not to.
* A brief NIOSH criteria document
(1974) titled "Exposure to Crystalline
* A 1978 joint NIOSH and OSHA publication
titled "An Occupational Health
Guideline for Crystalline Silica."
All of these studies agreed that companies should have some kind of medical surveillance program. They do, however, disagree quite readily on how often, what types of testing, etc.
In looking for additional input, the American Foundrymen's Society was very helpful to us. We also worked with our insurance program, Workmen's Compensation insurance and non-occupational insurance.
Our program was called Respiratory Medical Surveillance Program (RMSP), and its first task was to develop baselines. Although we had a number of X-rays and pulmonary function studies that we had planned to use for comparative tests, we wanted to start our new program with new X-rays and tests.
Since our study concentrated on silica exposure, it included one X-ray (a posterior/anterior chest view); and a spirometry study consisting of FVC (forced vital capacity), FEV1 (forced expiratory volume) and the FEV1/FVC ratio.
Potential result interpretation is usually done by a physician and a B reader. A B reader is capable of reading asbestos findings and may become the tiebreaker in the event of a medical dispute. it is important to involve him early in the program.
We needed a method to summarize all our data (a complete list of names, identification, test dates, categories of findings and classifications) because we had to know whether employees were medically stable or unstable.
Copies of the radiologist's narrative reports for positive findings, a printout of spirometry test and the X-ray findings are necessary
When providing medical screening for employees, the employee must be given all results in writing. This is a very important detail. You will be placed in a dangerous position if negative evidence is unreported. We make it absolutely certain that we get test results in writing.
At the beginning of the second year, we performed a trend analysis to check our program direction.
Implementing the Program
Since we knew the program would require maintenance, three types of testing programs were investigated. One option was to run the program in-house because we had the X-ray and spirometer equipment and a registered pulmonary health professional in-house.
The second option that we investigated was contracting with a local hospital. We're located in a small community (pop. 30,000) with a number of local hospitals. This option appeared to be insurmountable because of the time involved.
The third option was a mobile testing company that we judged as the medical testing group most qualified to perform our testing. It had an experienced staff, was cost effective and performed on-site testing. The firm also was familiar with high-volume work and was able to meet shift needs.
We needed a complete package when considering contractors-including documentation, equipment and supplies, physicians, a B reader and technicians. All would be important factors in maintaining a program.
We introduced the program to the employees by holding group meetings. We kept the groups relatively small-15-25 employees-and 15-25 prepared a short slide presentation acquainting them with the new program and our Hearing Conservation Program.
When we started our program, all employees were involved, not just the foundry workers. Many of our engineering and office employees had previously worked out in the foundry or frequented the foundry floor.
During the orientation, we explained the details of the test and tried to diminish any fears or apprehensions an employee may have had about taking them. We explained the probable results and what they represented.
Most of our employees would be given a chest X-ray every five years, and pulmonary function studies were to be conducted every year. Due to test results and technical problems, etc., there may be higher frequency rates for certain employees at the physician's request.
The paperwork must be done prior to testing. We gave employees time to fill out the history forms. Complete employee lists with names, Social Security numbers, years of service, job title and location are all necessary for your contractor.
It took Lufkin approximately a day and a half to test 300 employees. Our employee orientation allowed us to speed up the test process because most questions had been answered during orientation.
When we began this program in 1989, we ran 290 tests and classified the results into five categories: Category 1, normal; 2, borderline; 3, medical review; 4, retest; and 5, nonpulmonary medical problem.
In 1989, 46 of the 290 tested were borderline. Borderline isn't necessarily a problem, meaning only that the patient needs to be reevaluated. Perhaps comparisons need to be made with previous X-rays from preplacement physicals. Some of the employees were removed from that list the following year.
There were seven people in the medical review category. Most did not have occupational problems. Five of the seven were already under a physician's care and were aware of the situation. Three were retests as the result of a technical error. There were six nonpulmonary medical problems related to broken bones, shrapnel, etc.
The pulmonary function test (Category 1) found 281 normal and six borderline cases. In this case, the borderlines were retested in six months. There were two medical reviews. Since some borderline-medical review patients were from the same group that had positive X-ray findings, they were retested.
In February 1990, we only ran 35 X-ray tests. We had worked all the other cases out of the system. Most of the employees now are on a five-year cycle. All of the other borderline areas had been worked out in the interim and were no longer classified as problems. There were 15 borderline, one medical review and from the pulmonary function tests there were 248 normal, seven borderline, one medical review and one retest.
Our program was very well received by the employees and it was a program we felt good about. When any problems arose, especially with medical reviews, we asked employees to report to our first-aid department for counsel with our company nurse. This information is placed in the employee's file.
Our respiratory Medical Surveillance Program has been very successful. In the occupational disease area, for silicosis, we have had only two questionable cases. We are much improved in our disease prevention. We know exactly where we stand now.
Some medical surveillance costs are as follows: In 1989, at the program's onset, the total program cost was $13,294 (X-rays were about $35 each and the PFTs were around $11, roughly $45-50 per employee). By comparison, our program costs were $4052 in 1990. Once the system was running, it was less costly to maintain.
|Printer friendly Cite/link Email Feedback|
|Title Annotation:||Focus on the Environment|
|Date:||Feb 1, 1991|
|Previous Article:||Environmental assessments & audits.|
|Next Article:||How to sell your company: the art of deal making.|