Text For Citation: 02 Item/Group: 003B 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 the medical management practice of delaying employee access to appropriate medical evaluation and care caused employees to sustain considerable pain and suffering, which did or could have caused employees to sustain permanent debilitating illnesses. 1) Instances in which employees were delayed in having access to appropriate medical care for detection and treatment of Cumulative Trauma Disorders (CTDs) often resulting in serious physical harm, pain and corrective surgery. a) An employee, #08100189, was delayed access to appropriate medical evaluation and care in that after asking to see a physician several times beginning in November 1988 for hand and wrist pain, he was finally referred by the nurse to a physician in July 1989. He had surgery on the right hand on August 3, 1989. $10,000.00 b) An employee, #09100986, was delayed access to appropriate medical evaluation and care after having complained to the nurse in April 1986 and for the next five months. The nurse and personnel manager refused to send the employee to a physician and told the employee to see her own physician and take care of it through her personal insurance. Employee went to her own physician and on September 13, 1986 had to have bilateral wrist surgery because of the work related CTD. $10,000.00 c) An employee, #11101488, was delayed access to appropriate medical evaluation and care since December 7, 1984 after experiencing severe pain on both hands. The employee was told by the personnel manager to go to her own physician and have her personal insurance handle her problem. The employee went to a physician 10 times using her personal insurance between December 7, 1984 and October 28, 1988. Employee had to have surgery on November 9, 1988 of the right hand (CTD) and November 23, 1988 of the left hand (CTD) which resulted in the employee having a permanent partial disability to both hands. The personnel manager asked the physician not to operate on both hands on November 9, 1988. $10,000.00 d) An employee, #08101089, was delayed access to appropriate medical evaluation and care in that the employee reported shoulder pain on April 27, 1989 and was told by the nurse that, "you're just going to have to learn to live with it". Employee was given a wrist brace by the nurse and told that shoulder pain might be due to a wrist problem. The employee made an appointment to see a physician in June 1989 because the company would not make an appointment for the employee to see their physician. On August 23, 1989, the employee underwent a right-distal clavicle excision surgery. $10,000.00 e) An employee, #08101189, was delayed access to appropriate medical evaluation and care in that neither the employee's complaint of bilateral wrist pain in March 1989 nor the request to see a doctor in June 1989 were addressed until August 9, 1989, when the employee was sent to the company physician. A bilateral CTD surgery was performed on August 30, 1989, after which the physician stated that "if you would have gotten here 3 months before, this (surgery) never would have happened". $10,000.00 f) An employee, #07100289, was delayed access to appropriate medical evaluation and care in that after complaining of severe pain in both hands on July 27 and 31, 1989 and asked to see a physician, she was denied the opportunity to see the company's physician by the nurse. Employee was told by the nurse to make an appointment with her own physician and handle with her personal insurance. Employee made appointment with her personal physician who stated on August 8, 1989 that she had CTS in right hand and severe tendonitis in both. Employee had bilateral hand surgery on October 4, 1989. $10,000.00 g) An employee, #06100786, was delayed access to appropriate medical evaluation and care in that, after having complained of shoulder pain on November 8, 1988, and of bilateral pain on December 6, 1988, the employee was sent to a physician on April 10, 1989, whereupon it was revealed that the patient had suffered a 12% permanent partial disability due to an occupational illness to the shoulder. $10,000.00 h) An employee, #11100587, was delayed access to appropriate medical evaluation and care in that after having complained on November 25, 1986 and many times thereafter, of right wrist pain and waking up at night, the employee was allowed to see a physician on December 2, 1987. $10,000.00 i) An employee, #07100488, was delayed access to appropriate medical evaluation and care in that the employee requested to see a doctor in April of 1988 and was not granted a request to see a physician until July 5, 1988. There is a first aid log entry stating employee had significant pain on in both arms on March 14, 1988. $10,000.00 j) An employee, #10100388, was delayed access to appropriate medical evaluation and care in that after having hand numbness for two days, the employee reported to the nurse on September 16, 1987. The employee was finally referred to a physician on October 25, 1988, who upon receipt of the patient, scheduled surgery for the next day, October 26, 1988. $10,000.00 k) An employee, #06100786, was delayed access to appropriate medical evaluation and care in that after complaining on June 18, 1986, the employee was able to see a physician on September 8, 1986. Surgery was on May 22, 1987; arthroscopy of the left shoulder. $10,000.00 There are 23 instances $10,000.00 for a total penalty of $230,000.00 While ultimate responsibility for correcting the hazard rests with the employer given his superior knowledge of the operation, feasible, and acceptable abatement methods to correct this hazard include but are not limited to: 1) Implement a comprehensive written compliance program including priorities for early detection, treatment, job ressignment and follow-up of CTD. The program shall include provisions for prompt recognition and evaluation of employee symptoms, scheduling procedure for employees to help them recover from CTD and surgery, and assurance of management's implementation of medical restrictions. This program shall be part of the overall written plan describing how and when each element will be accomplished. The overall plan shall be reviewed and updated quarterly to ensure goals are being met or to identify changes needed. 2. Implement a written program to identify employees developing CTD, and work methods and work stations causing CTD. a) Design a baseline symptoms survey to measure, on a plant-wide basis, the extent of employee awareness of their symptoms of work-related disorders. The results of which may be collected and processed by automated process. b) Conduct a plant wide symptoms survey and repeat it annually to detect any significant change in the incidence, scope, and/or location of reported symptoms. This survey will also help to determine the effectiveness of the overall medical management program and employees job rotation program as related to ergonomics. c) Each quarter health care providers shall review medical facility sign-in logs, OSHA-200 forms, and individual employee medical records to monitor CTD trends in the plant. This analysis shall be completed in addition to the "symptoms survey" in order to monitor trends continuously and substantiate information obtained in the annual symptoms survey. d) Compile, and keep current, a written catalog of job activities for each work position. The activity performed at the work position should be described and stressors identified as they affect specific parts of the body such as: physical stress, forces required to exert, posture (twisting, turning, lifting, bending, misalignment of body parts), workstation hardware, repetitiveness of activity, lack of breaks, tool design, training, employee turn over. A current catalog is very necessary to establish any "light duty" work positions and have an effective job rotation program. 3) Implement a written medical management protocol for CTDs. All physicians and nursed shall be qualified and trained to use this protocol which will include the following: a) A standardized physical examination, medical history and recording form. The examination will at least include inspection, palpation and range of motion testing and various applicable maneuvers, i.e. Tinel's test, Phalen's test, and Finkelstein's test. b) Specific protocols for the treatment of employees with positive physical signs on examination as well as those with symptoms but no physical signs shall be written and followed. Any symptoms with numbness or crepitus shall be referred to the company physician. In addition, employees with positive Tinel's, Phalen's or Finkelstein's tests shall also be referred for physician evaluation. c) Schedule re-evaluation in no less than three days after initital report of condition. If the condition worsens further medical management should not be undertaken without concurrent efforts to reduce the physical stresses of the job by such measures as job modification or work practice changes, administrative changes, etc. A follow-up evaluation shall be scheduled in no less than three days, whether the condition is worsened or unchanged. d) A protocol will be directed by a physician and followed by management which will allow sufficient time for the involved muscle/tendon/nerve group to heal. This shall include time off work, or transfer to another job which allows the affected muscle/tendon/nerve group to rest. When directed by a physician employees shall be given sufficient time for the involved muscle/tendon/nerve group to heal. This time shall include time off work, or transfer to another job which allows the affected muscle/tendon/nerve group to rest. Employees shall be evaluated by a physician to assess their capability to return to work. Upon returning to work, they shall, when directed by a physician, be permitted to recondition the injured muscle/tendon/nerve group by gradual resumption of duties. This should occur in addition to any other prescribed treatments. 4) Develop and implement a training program for the medical staff to include a detailed review of he medical aspects of CTD, and how to medically evaluate, treat, complete forms and reports, and to properly follow up. The training shall include recognition of plant job specific risk factors such as posture, force, repetition, vibration, contact nerve pressure, and cold. The additive effect of risk factors for CTD will be discussed along with an awareness of eliminating those which would aggrevate the specific condition of an employee. Medical personnel, including consultant physicians, will be informed as necessary as to the availability of light duty jobs appropriate for an employee with a specific condition. 5) Develop and implement a training program for all supervisors and employees to enable them to recognize early symptoms, the need for proper medical care, and the need to ensure work activities are compatible with employees physical conditions. 6) Conduct baseline health surveillance. The purpose of baseline health surveillance is to establish a base against which changes in health status can be evaluated. Workers being assigned to positions involving exposure of a particular body part to repeated biomechanical stress will receive baseline health surveillance. These positions will be identified from the data compiled in the catalogue of standard job descriptions. The baseline health surveillance will include a medical and occupational history, and physical examination of the musculoskeletal and nervous systems as they relate to CTD. The examination should include, inspection, palpation, range of motion (active, passive and resisted) and other pertinent maneuvers of the upper extremities and back. Examples of the pertinent maneuvers for the hands and wrists include Tinel's test, Phalen's test, and Finkelstein's test. Laboratory tests, X-rays and other diagnostic procedures are not a routine part of the baseline assessment. 7) Analyze light duty jobs for CTD potential. a) This written analysis shall include the procedures used in the performance of each job, including lifting requirements, postures, hand grips and frequency of repetitive motion. Such analysis shall be reduced to written form and provided to nurses, doctors, and supervisory personnel involved in the assignment of light duty jobs. b) When an employee in a job not previously evaluated reports a CTD to medical personnel, that employee's actual performance of the job shall be evaluated to determine if ergonomic risk factors exist and corrective action is necessary for the work station and work method. 8) Develop a policy to inform employees that they will 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. *STEP 1 - First Quarter, January 1 A) Submit to the Area Director a written compliance program and plan of action outlining a schedule for the implementation of this medical program to identify and control CTDs. Quarterly progress reports updating this program and plan will be submitted to the Area Director until final abatement. B) Design the baseline symptoms survey and complete catalog of job activities. C) Assure employee protection against discrimination. *STEP 2 - Second Quarter, April 1 A) Conduct a symptoms survey to identify CTD. B) Initiate quarterly records review to monitor CTD trends. C) Implement a medical management protocol. D) Implement medical supervisory and employee training. E) Initiate analysis of all light duty jobs. *STEP 3 - Third Quarter, July 1 A) Initiate baseline health surveillance. B) Complete analysis of light duty jobs. *STEP 4 - Fourth Quarter, October 1 A) Corrective action shall be completed by the implementation of all phases of this medical program.