November 26, 1990

Dr. Paul R. Eggum
Navistar International
Transportation Corporation
455 North Cityfront Plaza Drive
Chicago, Illinois 60611

Dear Dr. Eggum:

This is in response to your letter of November 1, seeking clarification of the "Occupational Exposure to Hazardous Chemicals in Laboratories" regulations, 29 CFR 1910.1450. Your question refers to paragraph (g)((4) Physician's written opinion.

The intent of the provisions is to obtain a written signed opinion from the examining physician containing the result of the medical examinations and the physician's opinion as to whether the employee has any detected medical conditions which would place the employee at increased risk of material impairment from exposure to a hazardous chemical found in the workplace. The written opinion must not reveal specific findings unrelated to occupational exposure and a copy of the opinion must be provided to the affected employee.

In cases where the employee has an existing health impairment that is not due to any occupational exposure but may predispose the employee to increased health risk when exposed to chemicals, the physician should indicate the general nature of the impairment (for example, weakened immunity or decreased lung capacity) and not reveal specific illnesses, such as AIDS or emphysema.

We hope we have adequately addressed your concerns. If we can be of further assistance, please do not hesitate to contact us again.

Sincerely,



Patricia K. Clark, Director
Directorate of Compliance Programs




November 1, 1990

Ms. Patricia Clark
Division of Compliance Programs
Department of Labor - OSHA
Room N 3461
200 Constitution Ave, N.W.
Washington, D.C. 20210

Dear Ms. Clark:

I have been referred to you by another OSHA office to seek clarification on the "Occupational Exposure to Hazardous Chemicals in Laboratories" regulations. My question refers to (g) 4 Physicians written opinion:

* B states: the results of the medical examination and any associated tests

* C states: Any medical condition which may be revealed in the course of the examination which may place the employee at increased risk as a result of exposure to a hazardous chemical found in the workplace

* Dii states: The written opinion should not reveal specific findings of diagnosis unrelated to occupational exposure.

As I read the regulation the requirements of B & C are contramanded in Dii. Further, B & C, as I understand them are contrary to the Code of Ethical Conduct for Physicians Providing Occupational Medical Services, a copy of which is enclosed. Please see article seven: ---"employers are entitled to counsel about the medical fitness of individuals in relation to work, but are not entitled to diagnoses or details of a specific nature."

I thank you for any clarification of language or intent to help me as a practicing occupational physician to follow the regulation and to abide by the ethical code of my profession.

Sincerely,



Paul R. Eggum, M.D., FACP, FACOM
American College of Occupational Medicine



 

Code of Ethical Conduct for Physicians Providing Occupational Medical Services

These principles are intended to aid physicians in maintaining ethical conduct in providing occupational medical service. They are standards to guide physicians in their relationship with the individuals they serve, with employers and workers' representatives, with colleagues in the health professions, and with the public.

Physicians should:

1. accord highest priority to the health and safety of the individual in the workplace;

2. practice on a scientific basis with objectivity and integrity; 3. make or endorse only statements which reflect their observations or honest opinion;

4. actively oppose and strive to correct unethical conduct in relation to occupational health service;

5. avoid allowing their medical judgment to be influenced by any conflict of interest;

6. strive conscientiously to become familiar with the medical fitness requirements, the environment and the hazards of the work done by those they serve, and with the health and safety aspects of the products and operations involved;

7. treat as confidential whatever is learned about individuals served, releasing information only when required by law or by over-riding public health considerations, or to other physicians at the request of the individual according to traditional medical ethical practice; and should recognize that employers are entitled to counsel about the medical fitness of individuals in relation to work, but are not entitled to diagnoses or details of a specific nature;

8. strive continually to improve medical knowledge, and should communicate information about health hazards in timely and effective fashion to individuals or groups potentially affected, and make appropriate reports to the scientific community;

9. communicate understandably to those they serve any significant observations about their health, recommending further study, counsel or treatment when indicated;

10. seek consultation concerning the individual or the workplace whenever indicated;

11. cooperate with governmental health personnel and agencies, and foster and maintain sound ethical relationships with other members of the health professions; and

12 avoid solicitation of the use of their services by making claims, offering testimonials, or implying results which may not be achieved, but they may appropriately advise colleagues and others of services available.