1. When entering areas occupied by a confirmed or suspect TB patient.

2. When performing high risk procedures on an individual with suspect or confirmed TB,and

3. When emergency medical response personnel or others transport, in a closed vehicle, an individual with suspect or confirmed TB.

A. No active T.B. cases or positive P.P.D. conversions in the facility for 15 years.

B. Each employee and patient screened for T.B. upon hire/admission.

C. Each employee screened annually for T.B.

D. In Kent County (the source of most staff and patients), there were 10 new cases of T.B. for 1990, 1991, 1992, 1993 combined, for an incidence rate of .06 cases per 1,000 population.

E. Contractual arrangements are in place with the local hospital to immediately transfer the patient even if "presumed" positive for active disease with return to the facility only after adequate therapy (per CDC guidelines).

The exact statement by the OSHA Representative was: "You must fully comply with the regulation including engineering controls or you would face willful violation sanctions if an active case occurs." The representative specifically stated that upon detection, exposure has all ready occurred and that a violation exists. In this sense, a violation can only be precluded if the individual is in an air controlled room and if the staff were wearing respirators before the illness is detected.

It is this type of ill informed, stringent application of regulations which is systematically paralyzing business in our country. If this isn't bad enough, the basis for the regulation may even be flawed. CDC or the DOL have determined that health care employees are at more risk of contracting T.B. than the general population. I wonder if this isn't because health care workers are continuously screened for T.B. (ie. more cases because of more monitoring vs. more cases associated with the work environment). This is a good example of a positive regulation gone bad before it's effective date by over zealous governmental employees.

If this regulation is implemented as told to me by OSHA, the long term care industry will be unable to comply in a manner which assures that they do not willfully violate it. We are being set up for failure. In an environment where everyone is calling for cost containment in health care, how does the Federal Government justify adding this cost to our operation when there can be no benefit shown? With no cases reported here (as far back as records can show) it should be evident that existing control measures are more than adequate and that additional measures (and cost) will provide no benefit to staff or patients. It will however increase cost substantially. Your help is needed to stop what I call "Regulatory Extortion." We are bullied into additional cost and compliance by the threat of a $70,000.00 willful violation punitive assessment.

Sincerely,



E. Ray Quillen, N.H.A.
Administrator