March 23, 1995

The Honorable Jesse Helms
United States Senate
Washington, D.C. 20510

Dear Senator Helms:

Thank you for your letter of February 9, on behalf of your constituent, Dr. James A. McQueen, MD. Dr. McQueen wrote to you in regards to Occupational Safety and Health Administration (OSHA) Tuberculosis (TB) regulations he believed were effective January 1.

In Dr. McQueen's letter he provided copies of several documents related to tuberculosis. These documents were not prepared nor issued by OSHA. OSHA has not promulgated regulations pertaining to tuberculosis. The material supplied by Dr. McQueen apparently was written by two physicians from Duke University and covers TB control in healthcare settings. The questionnaire and the drug treatment regime mentioned in Dr. Purcell's letter and provided in his enclosure are not OSHA requirements. OSHA's current inspection procedures are based on a compliance memorandum issued October 8, 1993 (enclosure). The enforcement guidelines from that memorandum follow the 1990 Centers for Disease Control and Prevention (CDC) Guidelines for TB. The provisions of the compliance memorandum would not become effective until there was an actual exposure case at a facility.

On October 28, 1994, the CDC issued their revised guidelines for Tuberculosis. Under these guidelines the recommendations apply primarily to inpatient health care facilities including hospitals, medical wards in correctional facilities, nursing homes, and hospices. The guidelines also include recommendations that apply to ambulatory care facilities, emergency departments, home health care settings, emergency medical services, medical offices, and dental settings. These guidelines are currently being reviewed by OSHA for the development of a compliance directive to replace the October 8 compliance memorandum.

Although the compliance memorandum is an enforcement policy, and not a regulation, OSHA has been petitioned by five different unions to develop a standard. OSHA is proceeding with rulemaking. When a proposed regulation is published in the Federal Register comments from the public will be solicited. Docket #H-371 has been opened for this purpose.

We hope that this letter addresses your concerns, if you have any further questions please do not hesitate to contact Richard Fairfax in the Office of Health Compliance Assistance at (202) 219-8036.

Sincerely,



Joseph A. Dear
Assistant Secretary

Enclosure



February 9, 1995

Mr. Tadd Linsenmayer
Office of Congressional Liaison
Occupational Safety and Health Administration
Department of Labor
Room N-362
200 Constitution Avenue, N.W.
Washington, DC 20210

Dear Mr. Linsenmayer:

I recently received the enclosed letter by Dr. James McQueen of Lauringburg, North Carolina in which he expresses concerns regarding the new T.B. regulations.

I appreciate any comments you have regarding Dr. McQueen's concerns. If you have any questions, please contact Lisa Rhodes, a member of my staff. Thank you for your time and assistance.

Kindest regards.



Sincerely,

JESSE HELMS:lfr

Enclosure



January 9, 1995

The Honorable Senator Jesse Helms
403 Dirkson Senate Office Building
Washington, DC 20510

Re: OSHA T.B. Regulations

Dear Senator Helms:

In my medical opinion the new OSHA T.B. regulations, effective January 1, 1995, (copy enclosed) represent unnecessary governmental intrusion into the practice of medicine, especially in the area of Pediatrics. Not only will the implementation of these regulations greatly increase the cost of medical care to our patient population, it will also offer little, if any, benefit in the area of general public health.

If I may offer only one example. The initial questionnaire is flawed and ill-suited for evaluating the Pediatric patient. A chronic cough in a child is a rather common complaint in a Pediatric practice, while T. B. in a child is a very rare occurrence, even in rural, indigent North Carolina. Moreover, a chronic cough is not usually a presenting symptom of childhood tuberculosis disease. Much more common causes of such a common cough include the following:

1) Upper respiratory illnesses, which may be caused by many viruses and may follow one another in rapid succession, especially in children in a school or day-care environment.

2) Smokers in the household or smoking by the children themselves.

3) Bacterial sinusitis superimposed on a viral U.R.I. 4) Mycoplasma (atypical) pneumonia. 5) Allergy induced cough, including asthma and reactive or hyperactive airway disease.

6) Exercise induced bronchospasm. 7) Habitual cough. 8) Even the aspiration of a foreign body, such as a peanut, into the pulmonary tract is probably more common than childhood tuberculosis disease.

Some children who present with a chronic cough will need medical tests, such as a chest x-ray, to establish the etiology of the cough. However, to subject all such patients arbitrarily to often unnecessary expensive tests, such as chest x-rays, seems, to me, unconscionable. The patient should be evaluated according to good individual medical judgment, based on medical history including family history, a thorough physical exam, and medically indicated lab and x-ray evaluations, not by governmental edict.

It should also be noted that even if a child does indeed have primary pulmonary tuberculosis, as opposed to an adult with cavitary pulmonary tuberculosis, he, the child, is not contagious and poses no public health risk to those around him. Therefore, the mandated mask and isolation precautions called for in the OSHA regulations seem ludicrous.

These are not the only problems with the OSHA T.B. regulations. But they are enough, I hope, to lead to a reassessment of these new expensive, expansive governmental regulations and their impact on the practice of Pediatrics in United States of America.

Thanking you in advance for your attention in this matter, I remain.

Sincerely,



James A. Mcqueen, M.D.

Enclosure