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Employee Medical Monitoring Program

Overview

Medical surveillance provides a clinical base of information that is used to evaluate an employee’s fitness to work in various hazardous environments, to identify anomalies in a person’s medical history that may be related to potential impaired health, and to evaluate a person’s capability to use respiratory protective equipment. This base of medical information includes personal health history, exposure history, physical examination results, laboratory analyses and the results of screening and special tests.

Examination

• The Initial Baseline Examination

The purpose of the baseline examination is pre-placement screening. All effected employees shall be given a baseline examination before being assigned to work with respirators or in occupations with known potentially hazardous exposures or Cal / OSHA regulated substances.

• Periodic / Annual Examination

All personnel who have taken the initial pre-placement examination and have reviewed clearance by the examining physician shall be re-examined periodically in accordance with hazard-specific regulations. The date of each periodic examination should fall on or as closely as possible to, the anniversary of the previous examination.

Any employee who has not participated in potentially hazardous work or who is no longer required to use a respirator during the 12 month period following his/her last annual examination, and who is not expected to continue to participate, may discontinue participation in the medical monitoring program as determined by campus Safety and Risk Management.

• Exit Examination

Upon termination of employment, employees who have worked with Cal/OSHA regulated materials and/or carcinogens shall undergo an exit examination consistent with their pre-employment medical evaluation. If the employee has had multiple positions during his/her tenure that have resulted in different medical evaluations, the employee’s exit medical examination will consist of a compilation of all the medical tests received during the employee’s entire tenure with the University. Additionally, the physician can recommend other tests as applicable.

The process of identifying/notifying employees and scheduling all exit medical examinations shall be coordinated between University Staff Human Resources (SHR) and SRM as follows:

• Staff Human Resources will provide a listing to SRM of employees who are separating from University employment for any reason. The list must be provided in time for adequate reviewed by SRM, and scheduling of an exit physical examination if required.
• SRM will review the list to flag any employees for whom medical monitoring has been provided as a result of job classification, assigned work practices, personal exposure, or any other related event for which SRM has provided exposure monitoring or other medical monitoring protocols that have generated an exposure record.
• If SRM finds employees for whom an exit physical examination is required, SRM will contact the employee, schedule the physical, and receive and cause to be maintained germane records of the examination. A copy of the examination results, and physical findings of the examination and recommendations from the physician will be provided to the employee.

If a medical exam has been administered within one year of exit, this requirement may be waived in certain cases, to be determined by SRM. However, the separating employee must have a termination (of program inclusion) physical examination and not have been exposed to asbestos or Cal / OSHA regulated carcinogens during this period.



• Special / Emergency Examination (situational medical clearance)

Special testing may be required on certain projects due to the potential for exposure to specific substances. This may be necessary where the potential for heat or cold stress exists, or after an exposure that results in a toxicity reaction. The need for special testing will be assessed on an ongoing basis. Emergency testing may be necessary in the event the of employee exposure.

• Physician’s reports

Examining physicians will use the information provided by the employee in the questionnaire, the examination results, and the results of the laboratory tests to determine if any work restrictions or occupational health problems appear to be present. The physician must send a report of the examination directly to the employee as will the campus medical record custodian who will maintain the employees records. These records are confidential and can only be viewed by the employee, the employee’s representative, and authorized representatives of the Chief of the Division of Occupational Safety and Health.

Non-work related health issues may arise during the course of the medical evaluation. The examining physician may recommend that employees see their family doctor or a specialist. Any additional tests required to investigate non-work related health issues will be the employee’s responsibility.

Objectives

The medical monitoring program has several specific objectives. These objectives are to:

• Evaluate the health status of potential employees, and determine whether they can perform the job in a safe and effective manner.
• Detect exposure-related adverse health effects at an early and hopefully reversible stage so that occupational diseases can be prevented, and proper medical care can be rendered, if necessary.
• Periodically assess employee suitability for ongoing or new assignments that involve potential contact with hazardous agents.
• Correlate past occupational or environmental exposures with future workplace activities and exposures, to arrive at an opinion on the risk that the job might represent to the health status of the individual.
• Provide a medical monitoring program that complies with all the pertinent Federal, State, and local regulations.
• Identify unrecognized effects of exposure by continually evaluating group employee health data to detect possible adverse health trends.

Access to Employee Medical Records

Employees, their designated representatives, and authorized representatives of Cal/OSHA have full right of access to relevant exposure and medical records. Designated representatives must be given the employees written authorization to exercise the right of access. The legal representative of a deceased or legally incapacitated employee may exercise full right of access to all of an employee’s medical record.

All requests for employee medical or exposure records shall be in writing to the University Medical Record Custodian. A copy or the requested records shall be provided to the employee or designated representative at no cost and no later than fifteen (15) days after the request is made. Copies of xray film, if a part of the medical record, will also be provided subject to availability. Whenever a record has previously been provided without cost to the employee or designated representative, the university may charge for the record search and the cost of additional copies.

In the rare case that a request for records is denied, the employee may appeal the denial to the Department of Occupational Safety and Health (DOSH), State of California. The chief of DOSH will make a decision on the appeal and may issue an order to release the information to the employee or their designated representative.

Designated representatives must be given the employee’s written authorization to exercise rights of access. A written authorization shall contain the following:

1. The name and signature of the employee authorizing the release of the medical information.
2. The date of the written authorization.
3. The name of the individual or organization authorized to release the medical information.
4. The name of the individual or organization authorized to receive the medical information.
5. A general description of the medical information that is authorized to be released.
6. A general description of the purpose for release of the medical information, and a date or condition upon which the written authorization will expire. The employee or representative will be provided a copy of the requested medical records at no charge to the employee.

Retention, Recordkeeping and Confidentiality

An important part of the Employee Medical Monitoring Program is the confidentiality of the medical and exposure records generated by the program. This program has been carefully designed to ensure that the medical information for individual employees be made available only to medical professionals ( including medical records services personnel) and the employee. Specifically, individual medical information is not available to CSULB management personnel, and in the absence of a subpoena, will not be made available to any person other than the employee or their designated representative of State or Federal regulatory agencies, e.g. Cal / OSHA.

To ensure that the employee has a complete understanding of these confidentiality procedures and the limited uses that will be made of the employee’s medical data, each CSULB employee enrolled in the Medical Monitoring Program is given an Authorization to Release Medical Information form. Employees are asked to sign the form before beginning an exam. The signed authorization form allows the occupational medicine provider to send the records to the campus.

Often, an employee may have undergone a previous medical examination. This information may be of value to the physician performing the exam. If the employee authorizes, copies of these old records may be obtained. The form, Authorization to Release Previous Medical Information, is to be used for this purpose.

Medical and exposure records are maintained for 30 years after the termination of employment at CSU, Long Beach.

Definition of Medical and Exposure Records

Medical records include the following:

1. Medical and employment questionnaires and histories.
2. The results of medical examinations and laboratory tests.
3. Medical opinions and diagnosis, progress rates and recommendations.
4. First aid records.
5. Description of treatment and prescriptions.
6. Employee medical complaints.

Medical records do not include medical information in the form of:

1. Physical specimens (e.g. blood or urine samples) which are routinely discarded as part of normal medical practice.
2. Records created solely in preparation for litigation which are protected from discovery under applicable rules of procedure on evidence.
3. Records concerning voluntary employee assistance programs.

Exposure records

1. A record containing measurements or monitoring results of the amount of a toxic substance or harmful physical agent to which the employee is or has been exposed.
2. In the absence of directly relevant records, records of other employees with past or present job duties or working conditions related to or similar to those of the employee, may be used to indicate the amount and nature of the toxic substances or harmful physical agents to which the employee is or has been subjected.
3. Exposure records to the extent necessary to reasonably indicate the amount and nature of the toxic substance or harmful physical agent at workplaces or working conditions to which the employee is being assigned or transferred.

Medical Monitoring Program Operations

Routine Examinations

Safety and Risk Management identifies employees covered by these regulations and coordinates the completion of baseline, periodic / annual and exit examinations with the employee or his or her supervisor.

Safety and Risk Management completes the Employee Medical Monitoring Examination Appointment form, which includes pre-examination instructions. One copy is given to the employee, another is sent to the employee’s appropriate administrator.

Safety and Risk Management prepares a package for the employee that includes:

1. Medical Monitoring Program Exam Appointment and Pre-Examination Instructions.
2. Authorization to Release Medical Information Form.
3. Authorization to release Previous Medical Information (if applicable).
4. Physical Examination Form.
5. The Health Status Report Form.
6. The Employee Medical Examination Findings Form.

The employee completes all applicable forms prior to the examination and observes the pre-exam instructions.

The employee attends the appointment.

The examining Physician completes Health Status Report Form and forwards it to Safety and Risk Management.

The examining Physician prepares the Employee Medical Findings Form and forwards it directly to the employee.

The examining Physician forwards records to the University Custodian of Medical Records.

Safety and Risk Management reviews the Health Status Review Form and initiates appropriate action.

Special Examinations

If situations arise in which an employee may have experienced a hazardous exposure or alleges symptoms, Safety and Risk Management will evaluate the potential workplace problems and may arrange for appropriate medical diagnosis and treatment if indicated or required.

Safety and Risk Management will contact the examining physician who will coordinate investigations and treatment to determine if overexposure to a hazardous substance has occurred.

An Incident Report detailing the hazardous exposure will be completed by the appropriate administrator and forwarded to Safety and Risk Management.