April 18, 2011

Dr. Jay Alexius
All Industrial Medical Services
855 Belanger Street Suite 207
Houma, LA  70360

Dear Dr. Alexius:

Thank you for your February 7, 2011 letter to the Occupational Safety and Health Administration (OSHA) regarding the recordkeeping regulation contained in 29 CFR Part 1904 - Recording and Reporting Occupational Injuries and Illnesses. In an effort to provide the public with prompt and accurate responses, we developed and continue to refine a set of Frequently Asked Questions (FAQ), in addition to maintaining a log of Letters of Interpretation (LOI) on the OSHA Recordkeeping web site.

In your letter, you are asking if "trigger point" injections can be considered diagnostic procedures for OSHA injury and illness recordkeeping purposes.  As you state in your letter, trigger point injection serves as both a diagnostic procedure and treatment of the injury.

Section 1904.7 General Recording Criteria

Section 1904.7(a) states that employers must consider an injury or illness to meet the general recording criteria, and therefore to be recordable, if it results in death, days away from work, restricted work or transfer to another job, medical treatment beyond first aid, or loss of consciousness.  A case would also meet the general recording criteria if it involves a significant injury or illness diagnosed by a physician or other licensed health care professional.

Section 1904.7(b)(5)(i) states that, for purposes of Part 1904, "medical treatment" means "the management and care of a patient to combat disease or disorder."  This section of the recordkeeping regulation also states that medical treatment does not include visits to a physician or other licensed health care professional solely for observation or counseling; the conduct of diagnostic procedures, such as X-rays (MRIs, Cat Scans, EMGs), and blood tests, including the administering of prescription medications used solely for diagnostic purposes (e.g., eye drops to dilate pupils); or "First aid" as defined by Section 1904.7(b)(5)(ii).

Section 1904.7(b)(5)(ii)(A) defines first aid, in part, as:  "Using a non-prescription medication at non-prescription strength (for medications available in both prescription and non-prescription form, a recommendation by a physician or other licensed health care professional to use a non-prescription medication at prescription strength is considered medical treatment for recordkeeping purposes)."  In addition, the preamble to the January 19, 2001 final rule revising OSHA's Part 1904 recordkeeping regulations states:  "In the final rule, OSHA has not included prescription medications, whether given once or over a longer period of time, in the list of first aid treatments."  See 66 Fed. Reg. 5986.

OSHA also explained in the preamble to the recordkeeping rule that the list of first aid treatments included in Section 1904.7(b)(5)(ii) is comprehensive.  This means that any treatment not included on the list is not considered first aid for purposes of Part 1904.  See 66 Fed. Reg. 5984.

Response:

Your letter indicated that the employee in question sustained a workplace injury.  Section 1904.7(b)(5)(i) states that the administering of prescription medication solely for diagnostic purposes is not medical treatment.  We have consulted with OSHA's physicians in the Office of Occupational Medicine and they indicated that although "trigger point" injections may be used diagnostically, ultimately they also provide medical treatment (pain relief).  Because the medication serves these dual purposes, it does not meet the criterion of being solely used for diagnostic procedure. Therefore, when "trigger point" injections are administered, the work-related injury or illness is recordable.

Thank you for your interest in occupational safety and health. We hope you find this information helpful. OSHA requirements are set by statute, standards, and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. This letter constitutes OSHA's interpretation of the requirements discussed. Note that our enforcement guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in responses to new information. To keep appraised of such developments, you can consult OSHA's website at http://www.osha.gov.

Sincerely,


Keith Goddard, Director
Directorate of Evaluation and Analysis