May 7, 1996

The Honorable Bob Graham
Unites States Senator
Post Office Box 3050
Tallahassee, Florida 32315

Dear Senator Graham:

This is in further response to your letter of January 31, on behalf of your constituent, Dr. David M. Mokotoff, of Bay Area Heart Center concerning the Occupational Safety and Health Administration's (OSHA) Bloodborne Pathogens Standard (29 CFR 1910.1030).

Dr. Mokotoff's employees attended a symposium on OSHA guidelines for medical practices. The information provided in the symposium raised concerns for the doctor. Dr. Mokotoff's concerns center on the designation of appropriate areas for eating, drinking, applying cosmetics or lip balm, and handling contact lenses; handwashing procedures; and information and training requirements for non-employees and employees. Also, the doctor raised concerns about the assessment of penalties for cited violations.

The Bloodborne Pathogens standard, paragraph (d)(2)(ix), prohibits these activities such as eating, drinking, applying cosmetics or lip balm, and handling contact lenses, only in work areas where employees have a reasonably anticipated exposure to blood or other potentially infectious materials (OPIM). The prohibition against food and drink and the use of personal items in such a work area is consistent with other OSHA standards and is good industrial hygiene practice. The employer/practitioner is free to designate an area where it is reasonable to anticipate that occupational exposure will fail to occur, and to allow the consumption of food and drink in those areas.

Dr. Mokotoff has been mistakenly informed that handwashing after patient contact for a bloodpressure check is an OSHA requirement. The bloodpressure check is a non-invasive procedure, and as such, employees would not have a reasonable likelihood of exposure to blood or OPIM. Hence, with bloodpressure checks, there is no requirement for handwashing by employees after patient contact.

In contrast, handwashing becomes a critical concern when the employee has occupational exposure to blood or OPIM, or when occupational exposure can be reasonably anticipated. OSHA recognizes this concern with paragraphs (d)(2)(v) and (d)(2)(vi) of the standard, stating employees must wash their hands after the removal of gloves and other personal protective equipment. Employees must also wash their hands or skin following contact with blood or other potentially infectious materials.

The Occupational Safety and Health Act extends protection only to employees, not to patients. Therefore, the Bloodborne Pathogens standard is applicable only to Dr. Mokotoff's employees. Dr. Mokotoff's concerns regarding this matter are unfounded since employers have no obligation under the Act to provide or implement any protective measures required under this standard, or any other standards to patients.

Dr. Mokotoff also expresses concern regarding training employees who have occupational exposure. Paragraph (g)(2) details employee training requirements, but essentially the standard emphasizes that the employer must provide information and training to those employees that have occupational exposure at the time of initial assignment and at least annually thereafter. Therefore, if the employee's initial assignment occurs on the first day of employment, the employer must provide the required training at that time.

Violations cited under OSHA's standards are classified as willful, serious, other-than-serious, and a notification of de minimis. These violations are assessed penalties based on the gravity of the violations. Each willful violation can carry a penalty of not more than $70,000. Serious and other-than-serious violations can carry a penalty of not more than $7,000. Although these are the maximum penalty amounts OSHA can issue, please bear in mind that OSHA's average penalty for a serious violation is less than $900. Factors such as employer work history and employer size are factored into determination of the penalty.

Thank you for your interest in safety and health and for seeking address to your concerns on OSHA and the Bloodborne pathogens standard. Should you have any further questions, please call OSHA's Office of Health Compliance Assistance at (202) 219-8036.

Sincerely,



John B. Miles, Jr., Director
Directorate of Compliance Assistance




March 6, 1996

The Honorable Bob Graham
Unites States Senator
Post Office Box 3050

Attention: Kristen Kershner
Tallahassee, Florida 32315

Dear Senator Monroe:

This in an interim response to your letter of January 31, on behalf of your constituent, Dr. David M. Mokotoff, of Bay Area Heart Center concerning the Occupational Safety and Health Administration's (OSHA) Bloodborne Pathogens Standard.

We are attempting to respond as expediently as possible, taking into consideration the need for a thorough and responsive reply. For an update on the status of your inquiry, please call OSHA's Office of Health Compliance Assistance within 30 days at (202) 219-8036.

Sincerely,



John B. Miles, Jr., Director
Directorate of Compliance Assistance




January 31, 1996

Assistant Secretary, OSHA
200 Constitution Avenue, Northwest
Room S-2315
Washington, D.C. 20210

Enclosed is a letter from one of my constituents who has concerns which come under the jurisdiction of your agency.

I would appreciate your reviewing this situation and providing me with an appropriate response. Please direct your reply to:

Kristen Kershner
Office of U.S. Senator Bob Graham
P.O. Box 3050
Tallahassee, FL 32315
Phone: 904/422-6114 or 422-6100
Fax: 904/422-6118

Your cooperation and assistance are appreciated.

With kind regards,

Sincerely,



United States Senator

Constituent's Name: Dr. David Mokotff



December 11, 1995

Senator Bob Graham
524 Hart
Senate Office Bldg.
Washington, D.C. 20510

Dear Senator Graham:

My office manager and nurse recently attended a symposium of OSHA guidelines as they apply to our medical practice. The course was sponsored last month at the Safety Harbor Spa in Safety Harbor, Florida, by Miriam J. Gray, R.N. The sponsoring organization was Suncoast Health Care. What they learned about federal OSHA guidelines for physician office practices was quite shocking. If you read on, I believe you will agree.

According to OSHA standards there is to be no eating, drinking, putting on cosmetics or lip balm, handling of contact lenses or chewing of gum in any area that is not specifically designated as a "non-exposure area." This means any area not in contact with patients. In our large office, this would basically mean the kitchen, one bathroom, and conference room and storage closet. We were informed that the fine for violation was $70,000.00!

Thus, if I drink coffee in my office consultation room, I am in violation of OSHA standards and subject to fining. If I place lip balm on my lips in my office consultation room, I am in violation of OSHA guidelines and subject to fining. If my contact lens falls out or needs adjusting and I do this in the bathroom, I am once again in violation of these guidelines and subject to fines. But this is not all. In fact, this is just the beginning.

We were told that after every patient contact by the nursing staff, they must wash their hands to be in compliance with OSHA standards. Patient contact includes checking of blood pressures. If we check blood pressure on one hundred patients a day, and it takes a minimum of thirty seconds to wash one's hands that calculates to over one hour per day in nursing time lost to hand washing for minimal patient contact; most of whom have no transmissible disease in a cardiology practice.

Furthermore, if we prescribe insulin to our diabetic patients, we are then responsible for supplying them with biohazardous waste training and supplies. Again, failure to do so is in direct violation of OSHA standards and subject to fines.

When my office staff asked where such rules were listed, so we could review them, they were told they were in the Federal Register. Of course, we were also told that it was our responsibility to seek out this information, and keep up with it should it change, as we would not be notified of such changes. Additionally, all employees were to be in-serviced on these standards and guidelines, on their first day of employment. After that, any OSHA inspection which revealed that any employee was ignorant of any of these guidelines could once again result in fining of up to $7,000.00

This above information was also extracted from OSHA Regulations (Standards) on OSHA CDROM, Wednesday, March 8, 1995. Part Number 1910 and Standard Number 1910.1030. Title: Bloodborne Pathogens.

Despite political rhetoric to the contrary, it would appear that governmental bureaucracy and interference has increased in the past few years. We are literally choking in regulations. I very much doubt that even the most ambitious and good-intentioned human beings can fall one hundred percent into compliance with these standards. In fact, I know of no physician's office or hospital, including the VA hospitals, which could pass these stringent requirements. Thus, it would appear that the federal government, through OSHA, has set up a system where we, as health care providers can only fail and be subject to completely arbitrary and horrify fines.

Your help, comments, and thoughts on this matter would be deeply appreciated.

Sincerely,



David M. Mokotoff, M.D.
President
Bay Area Heart Center