October 16, 1992

Carl Nabours, M.D.
Route 8, Box 191-Miller Lane
Lake Charles, Louisiana 70605

Dear Dr. Nabours:

Thank you for your letter of August 9, regarding your concerns about the Occupational Safety and Health Administration's (OSHA) regulations, particularly the Final Standard for Occupational Exposure to Bloodborne Pathogens and the Hazard Communication Standard (HCS). You expressed concerns about the necessity for these regulations and the costs to your business.

The Bloodborne Pathogens standard, 29 CFR 1910.1030, is designed to protect the Nation's workers, particularly health care workers, from exposure to the Hepatitis B Virus (HBV) and the Human Immunodeficiency Virus (HIV) of these two diseases Hepatitis B is more common, with 8,700 cases per year among workers in the health care profession. Hepatitis B infection may result in serious illness, potential long term disability and death. The HIV virus causes AIDS, for which there currently is no cure and which eventually results in death. These viruses, as well as other organisms that cause bloodborne disease, are found in human blood and certain other human body fluids. Therefore, employers have a particular responsibility to ensure that workers do not come into direct contact with blood or other potentially infectious materials while performing their job.

The development of this standard by OSHA took more than five years, beginning with close cooperation with the Centers for Disease Control, Department of Health and Human Services, on the development of a proposed standard. The proposed standard was based on the scientifically sound infection control practice of "universal precautions" originally established by the CDC for handling of body fluids known to transmit HIV.

During the development of the standard, compliance costs, those costs, incurred to meet the requirements, were extensively analyzed. All OSHA workplace safety and health standards undergo a similar, very stringent, review. A key component of this review was a 3,500-facility survey, which included both large and small physicians' and dentists' offices, funeral homes, nursing homes, and blood banks among others. This survey showed that many offices were already complying with many provisions of the standard, including practicing "universal precautions."

The second OSHA regulation that you raise concerns about is the Hazard Communication Standard (HCS), also known as the "Right to Know" rule. OSHA promulgated HCS, 29 CFR 1910.1200, to ensure that the hazards of all chemicals produced or imported into the U.S. are evaluated, and that information concerning their hazards is transmitted to employers and employees. The standard applies to all chemicals to which employees may be exposed under normal conditions of use or in a foreseeable emergency.

All employers must provide information to their employees about the hazardous chemicals to which they are exposed by means of a written hazard communication program, which details how the information on labels and MSDSs (which accompany the initial shipment of a chemical product) will be transmitted to affected employees. The written program must also detail how employee training on the hazards associated with exposure to the chemicals present will be accomplished. The hazard communication program is to be developed, implemented and maintained at the workplace, and must include a list of hazardous chemicals known to be present at the worksite.

Whenever consumer products, such as Ivory or Comet which you mention in your letter, are used by employees in a manner that is not comparable to typical consumer use, the product is covered by the HCS. The standard requires the employer to ascertain whether the workplace use is more frequent, or of longer duration than would be expected in normal consumer use. Exposures in these situations would be greater, and thus the need increases for additional information for employee protection. The frequent use of Comet throughout the workshift, rather than for short or one- time applications that characterizes consumer use, is an example of hazardous chemical use which would not qualify as typical "consumer product use" and would be covered under the requirements of the standard. For example, employers would not be covered by HCS if an employee chooses to clean their desk with a product that is meant for cleaning purposes. However, employers would be required to comply with HCS if an employee's job duty includes cleaning desks, offices, bathrooms, and etc.

We understand your concerns about the increase in medical costs and the effect on health care availability. The standards were designed to protect the lives and health of workers. OSHA believes that the relatively modest costs necessary to comply with the standard will neither put small, independent physicians and dentists out of business, nor reduce the availability of health care for American families.

In order to explain the general requirements of the Bloodborne Pathogens standard OSHA produced a video titled, "As It Should Be Done." In addition, OSHA published five fact sheets on Bloodborne Pathogens and six Bloodborne Pathogens compliance assistance booklets, including booklets for acute care facilities, emergency responders, dentists, and nursing homes. The enclosed sheet lists titles and ordering information for all of these materials. A copy of the OSHA booklet "Chemical Hazard Communication" which explains the HCS and employer's responsibility under the rule and the OSHA compliance directive on HCS are also enclosed.

We understand that the cost of complying with OSHA's standards is of concern, and that most American health care professionals already follow safe practices; however, the risks of illness and death for American workers are too great to ignore, and they mandate the full employee protection and training required by these standards.

Sincerely,



Roger A. Clark
Director
Directorate of Compliance Program

Enclosures: Chemical Hazard Communication CPL 2-2.38C

August 9, 1992



President George Bush
1600 Pennsylvania Ave.
The White House
Washington, D.C. 20510

Dear Mr. President:

I am asking for your help with a bureaucratic mess created by OSHA. I hate to write to you about it, but staffers for my state's congressmen have been less than helpful. OSHA has invaded the healthcare field with a barrage of complex, time- consuming, and expensive though needless regulations.

The standards are absurd and have no scientific merit. I would like to give a few examples gleaned from a recent seminar to make this point:

(1) We have to document how and when our trash cans are cleaned.

(2) My nurse has to put on a gown, gloves, mask, and face shield just to draw blood.

(3) I have to maintain a book of information on chemical composition, toxicity, etc. for every substance used in my office as a physician-including such things as Ivory soap, Comet, etc. This fact will obviously surprise an OSHA official, but in 11 years of practice I have not seen or heard of a single death or injury from an Ivory overdose anywhere, much less a doctor's office.

(4) My electric outlets have to be color-coded with the breaker switches.

(5) OSHA doesn't think non-OSHA adults are smart enough o keep food and injectables separated, so I have to buy a second refrigerator for my office. I guess I've just been lucky for these 11 years.

(6) A wet diaper in anyone's home is just trash, but in my office it is now a more expensive trash that OSHA has decided it is hazardous waste.

(7) Employees are also accountable for any minute infractions and so live in fear of heavy fines or loss of license.

This list goes on ad nauseum. It is long, complex, ambiguous, and very difficult to digest. I have done fine in my office all these years without these regulations, as have all the other doctors I know. These rules cannot improve an excellent record. They serve only to create work for bureaucrats who have no honorable work to do. OSHA can be of value in the industrial workplace where real hazards to workers may exists, but these hazards do not exist in physician offices. The absurdity of all this is hard to believe, but OSHA's power to do harm is quite real. Individuals have these ridiculous rules dictated to them by people who are obviously working in an area where they are not qualified--then one is subject to heavy fines for violating rules that haven't even the remotest connection with common sense. This type of situation helps to fuel the resentment many of us feel toward a government that needlessly interferes in our lives.

Mr. President, this is a chance to undo a great disservice committed by our government. By your action to relieve us of this burden, you could win the hearts of thousands of Americans. Forcing OSHA to act only where real problems exist would also be a shot in the arm to small businesses throughout this country. We do not have time for the usual legislative channels, and so I am asking for direct executive action on your part. I believe your help would benefit so much, that it could help bring more substantial support toward your success this November. Please respond through your staff and let me know if I can count on help in the near future.

Sincerely,



Carl Nabours, M.D.