Text For Citation: 02 Item/Group: 002 Hazard: ERGONOMIC

Section 5(a)(1) of the Occupational Safety and Health Act of 1970: The employer did not furnish employment and a place of employment which were free from recognized hazards that were causing or likely to cause death or serious physical harm to employees in that employees who sustained cumulative trauma disorder(s) (CTDs) were exposed to increased risk of aggravation to existing injuries and illnesses and developing further injuries and illnesses by inhibiting employees from receiving adequate and timely medical care, by avoiding responsibility of employee's CTDs or by not complying with physicians work restrictions. (a) At Slaughter and Fabrication operation that have resulted in the development of CTDs, including at least 72 employees that required surgery between 1-1-89 and 7-15-91. (b) The employer failed to provide or inhibited employees from medical care. Instances include 20 employees that were denied access by supervisors after report of CTD pain and request for care. Four (4) employees were denied time off by supervisors to keep a scheduled appointment with a physician for treatment of CTDs. The on-site medical staff inhibited, denied, or failed to refer 50 employees to appropriate medical care when employees developed obvious CTDs as evidenced by employees personal physician, and requests by employees for appropriate medical care, even when an employee had been sent to the "company authorized physician" but was obviously and knowingly not provided medical examination and treatment. Of these instances described, 18 employees required CTD surgery at a later time. (The employees access to medical care was also deterred by lack of communication between the non-english speaking employees and medical personnel both on and off site.) (c) The employer attempted to avoid responsibility for employee's CTDs thereby exposing employees to increased risk of aggrevation to their existing illnesses. There were 30 instances where either the employer or the company authorized physician(s), who is an extension of the company's medical management program, suggested that employees, with CTDs, quit, resulting in employees seeking medical care at their expense. Nine (9) of these employees went on to have CTD surgery, (The lack of monitoring and tracking program for employees with complaints or diagnoses of CTDs contributed to avoidance of responsibility.) (d) There were 30 instances in which employees, given a physician's work restriction, were not put on work restriction or were placed in work positions that did not fulfill the the treating physician's idea of restricted duty. Ten (10) employees had surgery either before or after the restriction was violated; permanent partial disabilities have resulted. There was no concentrated effort on the part of management or medical to determine that the restricted duty job was lessening or worsening the employee's symptoms, and that the restricted duty was maintained until the employee's symptoms were resolved. Among other methods, one feasible and acceptable abatement method to correct this hazard is the implementation of an effective medical management program for CTD's. %% General %% The medical management program is to be established under the guidance of an appropriately qualified medical expert. It will include: 1. All employees visiting the plant medical facility to report injuries or illnesses will be asked whether their medical condition is caused or aggravated by work. were the employee states that the injury or illness id work-related, and that case otherwise meets the criteria for recording, the case will be entered on the OSHA log pending final determination of causation. 2. Educate all employees, supervisors, and foremen on the early signs and symptoms of CTDs and encourage the reporting of such signs and symptoms to the medical department. %% The physicians providing medical services to the company's employees need to be trained in the recognition, evaluation, and treatment of CTDs. Physicians providing medical services should show evidence of having attended a course or seminar dealing with CTD's, such as a 2 or 3 day seminar at a minimum. New employees will be given the opportunity to condition their muscles and tendon groups prior to working a full capacity (minimum 1 week). In addition, a CTD examination will be performed on all production employees 1 month after assignment and annually thereafter. %% 3. The institution of a formal, documented tracking and surveillance program to monitor CTD trends in the plant and those employees having contracted a CTD to ensure adherence to the above parameters. This will also provide information about the effectiveness of other aspects of the employer's program in decreasing the number and severity of CTD cases. 4. Employees shall not be discriminated against because they reasonably request and visit the medical facilities or because they have diagnosed CTD problems and are undergoing medical rehabilitation. 5. The institution of a formal job rotation program. %% Preventive Measures %% 1. Providing employees with early physician evaluation of CTD symptoms. 2. Allowing time off work for all muscle/tendon groups to heal after a CTD is diagnosed. The exact number of days off work is subject to each worker's individual response and should be determined by the physician. A physician must sign off prior to an employee being reassigned to job identified as posing high ergonomic risk factors. 3. The utilization of appropriate health care providers to develop and implement conservative treatment measures upon detection of CTD symptoms. It is encouraged that several physicians be available for employee referral and that employees be given the opportunity to see the physician of their choosing. %% Treatment of CTD Cases %% 1. Health care providers assigning rehabilitation jobs will ensure that the affected worker is assigned a job that will not further exacerbate the injury or illness. 2. After CTD surgery, allow time off work for all injured muscle/ tendon/nerve groups and the operative site to heal. Again, the exact number of days off work is subject to individual variation; however, the following averages are provided: After carpal tunnel release surgery and returning to low ergonomic risk jobs 3 weeks off medium ergonomic risk jobs 6 weeks off high ergonomic risk jobs 12 weeks off %% After surgery for trigger finger and returning to low ergonomic risk jobs 2 weeks off medium ergonomic risk jobs 4 weeks off high ergonomic risk jobs 6 weeks off %% However in no case shall employees be returned in less than: %% After carpal tunnel release surgery and returning to low ergonomic risk jobs 8 days off medium ergonomic risk jobs 21 days off high ergonomic risk jobs 42 days off %% After surgery for trigger finger and returning to low ergonomic risk jobs 7 days off medium ergonomic risk jobs 14 days off high ergonomic risk jobs 42 days off %% Step 1: Implementation of an effective medical management program for ergonomics, as detailed above. %%