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| Medical Assistant Medical Assistant Program Information: OSHA AND THE MEDICAL ASSISTANT How does OSHA affect the American Medical Assistant? OSHA's mission is to assure the safety and health of America's workers by setting and enforcing standards; providing training, outreach, and education; establishing partnerships; and encouraging continual improvement in workplace safety and health. How safe is your office? Beyond the goal of a better work environment, there's another good reason to take the question seriously. "Employees in physician offices are becoming more aware of the law and of their rights as employees," says Amber Hogan, former senior industrial hygienist with the Occupational Safety and Health Administration. The result: Complaints are on the rise, especially in the area of bloodborne pathogens. Between Oct. 1, 2000 and Sept. 30, 2003, OSHA cited physician and dental offices 480 times for violations of the rules on bloodborne pathogens, with total initial penalties exceeding $285,000. Luckily, the rules aren't that hard to comply with—and they do create a safer office. "We welcome the OSHA guidelines in my small practice," says GP Liza A. Shiff, of San Jose, CA. Here are the OSHA rules that require your special attention—and where you can turn for help if you need it. Seven rules for a safe and healthy practice There are six OSHA standards that apply to physician offices, whatever their size. A seventh standard—dealing with ionizing radiation—applies only to offices that offer X-ray services. Bloodborne pathogens. Aimed at reducing occupational exposure to bloodborne diseases, this rule targets the human immunodeficiency virus, the hepatitis B virus, and the hepatitis C virus. In 2000, Congress updated the rule when it passed the Needlestick Safety and Prevention Act. The idea was to get doctors and other medical providers to use newer, safer devices in order to reduce the risk of needlestick and other sharps injuries.* Among the basic requirements of the standard: • a written exposure control plan, updated annually to reflect changes in technology. The plan needn't survey every new device on the market, but it should show why you chose the various devices for your practice. Also, be sure to document the input of all employees involved in the selection processer. • use of safer, engineered needles and sharps • use of the right protective equipment (gloves, face and eye protection, gowns) • use of universal precautions • no-cost hepatitis B vaccines to exposed staff • medical follow-up after an exposure incident • proper containment of all regulated waste • identification (via labels or color-coding) of regulated-waste containers, sharps disposal boxes, and the like • employee training Practices no longer need to maintain a sharps-related injury log detailing when, where, and how injuries occurred—and which devices were involved. Hazard communication. If your office contains hazardous chemicals of any kind (alcohol, disinfectants, anesthetic agents, sterilants), your employees have the right to know about them. To comply with OSHA, you must have a written list of the hazardous chemicals stored or used in your office. For each of these, your employees must also have access to the manufacturer-supplied Material Safety Data Sheet. The MSDS outlines the proper procedures for working with a specific substance and for handling and containing it in a spill or other emergency. Exit routes. You must provide safe and accessible building exits in case of fire or other emergencies—something of particular concern to practices in larger physician-owned buildings. At minimum, you're expected to establish exit routes to accommodate all employees in a defined workspace and to post easily visible evacuation diagrams. Electrical. These rules deal with the safe use and location of such equipment as computers, faxes, copiers, sterilizers, centrifuges, refrigerators, microwaves, ECG and X-ray machines. There are also rules for offices that use special electrical equipment and wiring (because they store or use flammable gasses, for example). Reporting occupational injuries and illnesses. Medical and dental offices are currently exempt under federal law from keeping an injury and illness log. But you might be required to keep a log under state law if you practice in a state with its own occupational safety and health plans. (For a list of these states, see "States with OSHA-approved health and safety programs".) All work-related fatalities must be reported to the nearest OSHA office. You also must report to OSHA if three or more employees are hospitalized in a single work-related incident. OSHA poster. Every practice must display this notice of employee rights in a conspicuous place. (Liza Shiff of San Jose displays hers in the employee lounge.) Besides outlining your staff's rights to a safe workplace, the poster also must tell employees how to file a complaint. Posters can be downloaded from OSHA's Web site ( www.osha.gov/Publications/poster.html ) or ordered free-of-charge by calling 800 321-OSHA. Ionizing radiation. Practices that offer X-ray and related imaging services must: • survey the different types of radiation used • designate restricted areas to limit employee exposure • supply personal radiation monitors (film badges or pocket dosimeters) to employees working in restricted areas • label rooms and equipment, as needed, with caution signs Depending on the nature and location of your practice, you may need to take into consideration other OSHA guidelines or recommendations. The most common ones relate to latex glove sensitivity, ergonomics, indoor air quality, workplace violence, and injury and illness prevention. Stiff penalties for the seriously noncompliant To get an idea of the ways doctors get in trouble with OSHA, we took a look at inspection data from California. In 2002, that state's OSHA conducted 48 inspections of physician offices. All but three were in response to complaints. The most-often cited violation involved bloodborne pathogens, followed by injury and illness prevention program, formaldehyde, hazard communication, portable fire extinguishers, and electrical equipment. As a general rule, OSHA investigations occur in response to written, signed complaints. You can file a complaint by calling your local regional OSHA office. (For a list of regional and area offices, go to www.osha.gov/html/RAmap.html .) In states that have their own OSHA-approved state plans, employees may file a complaint with both state and federal OSHA. Complainants must provide enough detail for OSHA to assess whether the violation threatens physical harm or poses an imminent threat. Federal whistleblower laws prohibit reprisals against employees who file a complaint. In fact, if the complainant is an employee, her name will remain confidential and she won't be asked to attend any initial meeting with OSHA officials. An employee representative can substitute. The majority of OSHA complaints are handled as "phone/fax investigations"—informal alerts that deliver the message, "We're aware you may not be in compliance. How do you plan to address the problem?" But if the complaint involves a serious violation, or if the practice has a history of egregious or willful citations, OSHA will do an on-site inspection. These are generally limited to the area where the violation occurred, although an inspector may document other violations that are in plain sight. Inspectors may also ask to review your written exposure control plan, accident log, and other relevant records. Each citation issued carries a specific monetary penalty, up to $7,000 for serious violations and up to $70,000 for repeat violations. Not everyone pays the same amount, however. "Penalties are downscaled depending on the size of the business, its compliance history, its good faith efforts to correct problems, and other factors," says former OSHA official Amber Hogan. For example, an ob/gyn practice in Cherry Hill, NJ, was initially fined $6,375 for six violations of the bloodborne pathogens rules. An informal settlement with the local OSHA office reduced that penalty by 25 percent. Cited practices have a fixed amount of time to "abate"—OSHA-speak for fixing the problem and getting back into compliance. Pictures and a well-documented letter are acceptable proofs of abatement. One way to invite a more formal OSHA response is to ignore the alert, which some doctors have a tendency to do, according to Hogan. A world of resources at your fingertips If you're struggling with an OSHA-related issue, there's no dearth of resources available to help. One untapped resource, says Hogan, is OSHA itself—in particular its offer of free state-run consultation services, which are specifically designed for small businesses. "Physicians don't take advantage of these because they see them as somehow linked to enforcement," she says. "That isn't the case." OSHA insists that the purpose of its consultations isn't to issue citations or impose penalties. In fact, results of the consultation remain confidential. The AMA confirms that—since the mid-1990s, when physicians pushed for a change—OSHA has switched its focus from hardcore enforcement to compliance assistance and education. To get more information, go to www.osha.gov/dcsp/smallbusiness/consult.html This is not legal advise only information to show the importance to OSHA complience by Medical Assistants in the medical office. Medical Assistant need to be fimilar with OSHA laws in the United States. |
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