February 4, 1985

Mr. Milan Racic
Health and Safety Director
Allied Industrial Workers of America
A.I.W. Building
3520 West Oklahoma Avenue
Milwaukee, Wisconsin 53215

Dear Mr. Racic:

Your letter to Assistant Secretary Rowland dated December 12, 1984, recommending a field Instruction addressing the evaluation of X-rays and pulmonary function tests and relaying information to employees was forwarded to the Directorate of Technical Support for response. We apologize for the delay in responding.

As you know, and as Dr. Selikoff states in his letter to you, B-readers are an asset because they have been trained to interpret X-rays but there are many proficient physicians in the field who are not certified B-readers and nevertheless well qualified to evaluate pneumoconiosis. It would be difficult to set guidelines which would allow employers and employees to select physicians with such expertise.

Furthermore, asking employees to live with a diagnosis of lung "change" on X-rays or an altered pulmonary function test which reflects a decrement due to aging or smoking, may be contrary to the interests of the employee who may be deprived of a full life and wholesome employment for the wrong reasons.

The questions you raise are complex but will be given our full attention and we will explore the possibility of meeting your concerns, namely, early diagnosis of lung disease directly attributable to an occupational hazard.

Thank you for your continuing interest in occupational safety and health.

Sincerely,



Edward J. Baier
Director
Directorate of Technical Support



December 12, 1984

Mr. Robert Rowland
Assistant Secretary of Labor-OSHA
200 Constitution Avenue, N.W.
Washington, DC 20210

Dear Mr. Rowland:

This is in addition to my letter to you dated December 7, 1984. That letter contained various enclosures which were to give you the origin of and the rationale for my request.

At this time I would like to further explain why I think that the OSHA Field Directive pertaining to the subject of Asbestos exposures is essential if OSHA is to protect employees and prevent injuries at the workplace.

Please allow me a slight digression for a bit of historical narrative. Sometime in the latter part of 1970's the International Chemical Workers Union struck the Johns Manville Company in Waukegan, Illinois. This large plant was for a long time producing various Asbestos products including water pipes, pipe insulation and roofing material. When the television cameras came to the plant they were greeted with angry picketers. One of those workers, whom I will never forget, was a very slim man. He took his hat off and showed his totally hairless head. He told the interviewer that he was upset with the company because they did not tell him before that he has scarred lungs. He was most generous while saying this because he did not seem to be bothered as much with the fact that he has a lung cancer as he was with the fact that he was not informed of those lung scarrings before. He wanted to know so that he could exercise his option of an early retirement. Instead he was undergoing radiation treatment, which accounted for a total loss of hair and was facing a quick and a certain death.

I was moved by this and will remember this person forever. Still now, I think that he was most generous because he did not even threaten the company with a law suit or any other legal action. He only wanted to have time off while he was still relatively healthy and before his cancer developed, so that he could spend it with his family. That was, I hope you will agree, a very modest request.

However, that person as well as many others that came after, did not have to be informed then and do not have to be informed now by company doctors of their physical condition. The company did only what OSHA asked them to do: offer free medical examinations and make information available to the employees if they request. They did not have to inform their employees of early lung changes as well as the results of their pulmonary function test. Also, at present the employer's physician does not have to inform employees that B-readers are trained physicians capable of properly classifying X-rays of Asbestos or Silica exposed employees.

What I would like to ask is this: Issue a special Field Directive pertaining to exposure of employees to any pneumoconiosis producing dusts - including Asbestos, Silica and Cotton dust - and ask your field personnel to:

(1) Inform affected employees and employers that they may want to seek a B-reader or a physician who has established equivalent or better expertise to evaluate their X-rays and explain why their skills might be necessary i.e., some X-rays pertaining to pneumoconiosis might be misread by physicians. As a result affected employees are either not diagnosed at all or not diagnosed on time. Also, please emphasize in this Field Directive the importance of pulmonary tests and their value as early warning signals.

(2) Ask all employers and their physicians to inform the affected employees when first lung changes begin to show up or when their pulmonary function values begin to change. Also, request that employees be told what those changes mean, what their alternatives are (i.e., to be removed from the exposure etc.) and the basic science involving exposures to these materials. Also, request that employers advise affected employees of their right to obtain a copy of their medical file and the importance of seeing a physician of their choice, if further evaluation is warranted. In other words, employees should be informed immediately after any lung changes begin to take place.

These requests are not based on OSHA enforcement requirements but are, I think, in conformance with good medical practice. If this medical practice is being applied now in the patient/physician relationship it certainly ought to be applied in the employee/company physician relationship. OSHA, in my opinion, must serve as a catalyst and a motivator in this latter relationship.

I will be happy to meet or talk with you and assist you in outlining the language of this Field Directive.

I am quite certain that many people are falling through our present safety net. They are either without any compensation or without an adequate compensation. This should be unacceptable to you as much as it is unacceptable to me. Workers have a right to know. This information will provide the best incentive for others to prevent these types of exposures from continuing to take place in the future.

Since changing the Asbestos Standard would be rather cumbersome and time consuming and since OSHA is accustomed to issuing Field Directives, I think that this directive would go a long way in protecting thousands of workers from the development of unnecessary occupational diseases. It will help take some workers out of exposure risks, it will prevent some first time exposures and it will also provide an alternative for those already affected. This Field Directive would not have the enforcement power but would put everyone on notice that further avoidable exposures would not be acceptable and that the issue of proper medical diagnosis must be addressed immediately.

Please give this request a very high priority and please let me know what your immediate course of action, regarding this important matter, is going to be.

Sincerely,



MILAN RACIC
Health and Safety Director
Allied Industrial Workers of America
A.I.W. Building 3520
West Oklahoma Avenue
Milwaukee, Wisconsin 53215