OCCUPATIONAL HEALTH PROGRAM

MEDICAL MONITORING
EXECUTIVE SUMMARY

As part of the Occupational Health Program at CSUSM, RM&S has established a health monitoring program. The reference California Code of Regulations is Title 8:

Section 5097 for employees exposed to hazardous levels of noise
Section 5144 for respiratory protective equipment
Section 5191 for employees engaged in the use of hazardous materials in laboratories
Section 5209 for employees engaged in work involving carcinogens
Section 5217 for employees exposed to formaldehyde National Institutes of Health for employees required to handle animals 10 CFR, 20 for employees exposed to radiation from Tritium or other sources of radiation 49 CFR, Part 391 for employees driving passenger vans

The purpose for performing medical monitoring of employees is to detect physiological changes in an employee, that may be the result of exposure to hazardous levels of physical, chemical or radioactive stresses the employee may experience on the job. Supervisors will make every effort to minimize the occupational exposure of employees to hazardous environmental stresses, by utilizing engineering and administrative controls on processes. Medical monitoring of employees is also used to measure the effectiveness of engineering and administrative controls. Biological monitoring is a part of the medical monitoring program. Biological monitoring can provide a reasonable indication of exposures to hazardous environmental stresses the employee might encounter on the job. Biological monitoring is also an attempt to quantify an employee's exposure for a period of time either prior to, or as a result of employment at CSUSM.

This program was compiled from data contained in; The California State University Employee Medical Monitoring Program, sample plan, NIOSH/OSHA Occupational Health Guidelines for Chemical Hazards, 29 CFR 1910 series, Title 8, California Code of Regulations, Sections 5097, 5208, 5144, 5191, 5209, 5210, 5213, 5216, 5217, 5218, 5220, 6053, 6728 and 6760, and 49 CFR, Part 391.
 

OSHA STANDARDS AND REGULATORY COMPLIANCE

Background

CSUSM is under the mandate of the California Occupational Safety and Health Act (CAL/OSHA). In addition, other branches of the federal and state government promulgate regulations pertinent to certain CSUSM employees. Examples of regulations pertinent to CSUSM employees include California General Industry Safety Orders, Title 8, Sections 5097, 5208, 5209 through 5216, 5217, 5218, 5220 and 5144. Title 3 of the California Code of Regulations, Sections 6728 and 6760, are pertinent to pesticide workers. Code of Federal Regulations 29, parts 1910 and 1920, mandate comprehensive medical examinations for employees involved in hazardous waste operations and emergency response. The comparable state regulation, Title 8, CCR, Section 5192, has been finalized. Title 17 of the CCR, Section 30277, deals with radiation protection, and each user may be required to undergo bio-assays and medical review. Recently, biological hazards have been addressed in CFR 1910.1030. The state regulation dealing with biohazards is addressed in Title 8, CCR, Section 5231. Title 8 CCR sections 5193 and 5194 address some areas relating to biohazards. No specific regulations are promulgated regarding animal handlers, but medical monitoring programs are recommended by the National Institutes of Health. Regulations have also been promulgated by CAL/OSHA for employees operating video display terminals. Commercial drivers medical monitoring programs are located in 49 CFR, Part 391.

Appendix A contains an evaluation of the following regulations, including a synopsis of the medical monitoring requirement.

Occupational Noise 8 CCR 5097
Hazardous Waste Workers 8 CCR 5192
Respirator User 8 CCR 5144
Laboratories 8 CCR 5191
Carcinogens 8 CCR 5209
Asbestos 8 CCR 5208
Vinyl Chloride 8 CCR 5210
Acrylonitrile 8 CCR 5213
Lead 8 CCR 5216
Formaldehyde 8 CCR 5217
Benzene 8 CCR 5218
Ethylene Oxide 8 CCR 5220
Divers 8 CCR 6053
Pesticides and Pest
Control Operations 3 CCR 6728, 6760
Ionizing Radiation 17 CCR 30277
Animal Handlers No Regulation
Biohazards 8 CCR 5231 (proposed), 8CCR 5193,5194 (CFR 1910 1030)
Fetal Protection No Regulation
Commercial Drivers 49CFR, Part 391

In addition to regulations mandating medical monitoring, other regulations exist dealing with confidentiality and access to medical records. A complete understanding and knowledge of these regulations is required for the Environmental Health and Occupational Safety personnel administering an employee medical monitoring program. The personnel of Human Resources Management will manage the health records. A synopsis of Title 8, CCR, Section 3204, Access to Employee Exposure and Medical Records, and a complete copy of the regulation, are provided in Appendix A.

RECORDKEEPING AND CONFIDENTIALITY

An important part of the Employee Medical Monitoring Program is the confidentiality of the medical information generated by the program. This program has been carefully designed to ensure that the medical information for individual employees be made available only to medical professionals (including medical record keeping personnel and the employee). Specifically, individual medical information is not available to CSUSM management personnel, and, in the absence of a subpoena, will not be made available to any person other than the employee or his/her designated representative, and authorized representatives of State and Federal Regulatory Agencies, e.g., Cal OSHA.

To maintain the confidentiality of the data, while at the same time ensuring that all information is thoroughly evaluated, review of all the medical records generated by the Medical Monitoring Program and the employees' work exposure histories, will be conducted by the contract medical provider contracted to CSUSM. To ensure that the examinations are complete and that any possible correlation between work exposures and adverse health effects are thoroughly investigated. The contract medical provider will forward records to HRM, who will archive all the employee medical records in locked file cabinets for the duration of employment. Once the employment ceases, the records are forwarded to the Chancellor's office, per CSU Employee Medical Monitoring Program Manual, for permanent storage for at least 30 years.

To ensure that the employee has a complete understanding of these confidentiality procedures and the limited uses that will be made of the employee's medical data, each CSUSM employee enrolled in the Medical Monitoring Program is given an Authorization to Release Medical Information Form (Form EHS-003). Employees are asked to sign the form before beginning an exam. The signed authorization form authorizes the medical clinic to send the medical records to HREO.

Often, an employee may have undergone a previous medical examination. This information may be of value to the physician performing the exam. If the employee authorizes, copies of these old records may be obtained. Form EHS-004, Authorization to Release Previous Medical Information, is to be used for this purpose.

FORMS AND INSTRUCTIONS

There are a number of forms for use in the CSUSM Employee Medical Monitoring Program:

Employee Medical Monitoring Exam Appointment Form

This form (EHS-001) is completed by RM&S when the monitoring examination is scheduled. The form indicates the date, time, and location of the medical examination. A copy of this form is forwarded to HREO by RM&S so the record custodian knows when to anticipate other documents.

Medical Monitoring Pre-Exam Instructions Form

This form (EHS-002) explains the pre-examination form completion and dietary instructions.

Authorization to Release Medical Information Form

This form (EHS-003) is prepared and signed by the employee, and is used to facilitate a release of the patient's physical examination to HREO (medical record custodian).

Authorization to Release Previous Medical Information Form

This form (EHS-004) is prepared and signed by the employee and will be (if requested) utilized by the present examining physician to gain information about an employee's past exposure history.

Occupational/Medical History Questionnaire Form

Prior to going for the examination, the employee shall complete the medical questionnaire (Form EHS-005). This questionnaire contains demographic information and the Pre-Assignment Evaluation Form. This form summarizes exposures or anticipated exposures that the employee may incur. It is completed by the employee and the employee's supervisor. It also serves to notify the examining physician of any tests required in addition to the core panel.

This questionnaire is used for pre-placement, annual, and exit examinations.

Medical Examination Form

The form (EHS-006) is to be brought to the medical

clinic and completed by the examining physician. It shows the results of the examining physician's physical examination, and includes an area for notation of the vital signs, urinalysis results, visual acuity results, and evaluation of the upper extremities and the lumbosacral spine.

Health Status Medical Report Form

This form (EHS-007) is brought to the medical clinic, by the employee. The examining physician will evaluate all the examination data and forward the completed form to RM&S, whose responsibility is to ensure compliance with recommendations. Copies of this form, the questionnaire and the other exam results are forwarded to the medical records custodian in HREO by the examining physician.

Employee Medical Exam Findings Form

This form (EHS-008) will be completed by the examining physician. This form is sent directly to the employee along with copies of the medical findings and recommendations.

Public Safety Officer Medical Report

This form (EHS-009) is to be completed by University Police Officer prior to being seen by physician.

Commercial Drivers License Form

The form DL51 (Medical Examination Report) and form DL51A (Medical Examiner's Certificate) are utilized for this program. The required medical exam items are listed on the form.