The Last Physician/Medical Officer Position is Eliminated at Cal/OSHA.
Save the PHMO Position!!
The Cal/OSHA public health physician position is an integral part of the
Cal/OSHA program. In the heyday of the program, there were three
occupational health physicians, as well as several nurse consultants. We are
now down to one physician and two nurse positions.
The occupational health physician:
1. Provides medical expertise to link exposures to employee illness,
particularly when those exposures are not already controlled by regulations.
Often, these investigations are in new technologies, or new uses of
chemicals, for example in the biotech industry.
2. Interprets medical records and provides medical testimony at hearings.
Medical record review is necessary in all repetitive motion injury cases. It
is also necessary to establish that an employee has sustained a "serious
injury" as defined by the Labor Code in order that accident-related
penalties are applied.
3. Recommends and evaluates medical surveillance programs both for chemical
hazards and biological agents. For example, the physician helped to
establish Cal/OSHA protocols for requiring control measures for
tuberculosis, in health care settings, prisons, and other high risk
situations. The physician evaluates the results of biological monitoring for
exposure to toxic agents.
4. The Cal/OSHA physician recommends special orders in workplaces where
there is no existing standard to address hazards. These special orders have
included protecting employees against Q-fever, tuberculosis, ergonomic
hazards, and heat stress.
There are many other functions that the physician provides, including
mentoring occupational medicine residents, serving as a resource in
regulatory development, interfacing the program with the medical community,
and providing advice in individual cases and in the development of programs
It is critical to maintain this position, since once lost, it is unlikely to
Larry Rose M.D., MPH
Cal/OSHA Medical Unit
Cal/OSHA Alert: Cal/OSHA Functions at Risk
The last remaining Occupational Medicine physician in the Cal/OSHA
program is being eliminated. This important position was selected for
elimination due to the reduction in the overall budget for the Division. It
is 50% funded by federal funds. This creates a crisis in the effectiveness,
and credibility of the entire Cal/OSHA compliance and consultation programs.
The Cal/OSHA Medical Unit Physician functions in close coordination
with the compliance safety and health officers whenever there is a medical
problem caused by workplace environmental exposures. This coordinated
investigation usually consists of on-site interviewing of affected employees
reviewing doctorıs first reports, interviewing evaluating/treating
physicians, and obtaining all up to date relevant medical records.
There are several specific substance standards, (e.g. lead, asbestos,
arsenic, etc,) that require detailed medical surveillance when various
trigger exposure levels occur. Whether or not the requirements of these
standards are met needs the review of a health care professional.
At a certain high level of exposure to any toxic that is causing a serious
health reaction immediate, and ongoing medical surveillance can be required.
This can only be developed by interviewing all exposed employees, reviewing
all work related medical records, and looking at past and probable future
exposures to determine the initial and ongoing periodic medical surveillance
The main investigations where participation of the Medical Unit physician
are critically important are:
1. The Ergonomic Standard (Title 8, 5110), where only the physician in the
Medical Unit can make the contacts to determine that each injury recorded is
a true repetitive motion injury primarily caused by job task factors.
2. The Bloodborne pathogen standard (Title 8, 5193). This complex, very
detailed standard requires a thorough up to date grasp of the rapidly
changing risks for transmission of HIV and hepatitis in hospitals, clinics,
and other health care settings where health care worker exposures occur. The
adequacy of the needlestick prevention programs, the needlestick post
exposure prophylactic programs, training, engineered sharps program, is a
constantly changing picture, and needs a health care professionalıs
evaluation in the course of any bloodborne pathogen investigation.
3. Infectious disease exposures such as tuberculosis, SARS, Q Fever,
Coccidiocycosis, rabies, Legionaireıs disease, and bioterrorism organisms
such as anthrax, smallpox, need the input of the Medical Officer responses
for credibile effective response to employee concerns and complaints.
4. Indoor air quality health complaints, need Medical Officer reviews. True
building related illnesses such as asthma exacerbations, Legionairesıs
Disease, upper respiratory infections, CNS reactions, need to be evaluated
using treating physician interviews, and medical records. Linking specific
health reactions to airborne conditions in various building areas needs
special medical input. Multiple Chemical Sensitive employees often need
5. Often employees that are expose to carcinogens, reproductive hazards,
hormone disruptors, and CNS toxics, need detailed review to direct exposed
employees to selected health care specialists.
6. Clusters of cancers, adverse reproductive events, and other medical
diagnostic catagories frequently require epidemiologic screening.
In addition to the above six categories of frequent investigation
participation the Medical Officer:
1. Supervises the medical surveillance program of Cal/OSHA compliance
2. Participates in fatality investigations
3. Evaluations of new or emerging diseases, or health issues.
4. In legal appeal, and settlement proceedings gives input in depositions,
and as an expert witness.
5. Frequent telephone responses to employee, and employer inquiries about
health reactions and prevention as related to workplace exposures.
6. Develops health Hazard Alerts.
7. Advises health care professionals regarding Cal/OSHA requirements.
8. Helps screen health complaints for district offices (particularly
9. Responds to telephone inquires about health reactions, and prevention as
related to Cal/OSHA regulations.
10. Lectures to heath care workers when requested.
11. Consultations with employers when requested.
12. Developing and coordinating the residency training program at Cal/OSHA
as a member of the Department of Medicine at UCSF.
13. Liaison with infectious disease departments, and CDC.
14. Interacting with other state agencies such as DHS, EPA, Pesticide
15. Developing standards.
16. When Employees are exposed to high levels of toxic materials Cal/OSHA
can require a Medical Surveillance program. The development of this program
includes interviewing exposed workers, review of past and probable future
exposures, and a medical determination that includes items of appropriate
surveillance protocols such as: laboratory tests, X-rays. lung function
tests, and biologic tests.
If the Public Medical Officer position in Cal/OSHA is eliminated, no one in
CAL/OSHA will be able to effectively fill these critically important
Proposition 97 passed by the electorate in1989 required that the state OSHA
program should be reinstated at the previous level of effectiveness. The
Cal/OSHA program is now responsible for protecting the health and safety of
more than 17 million workers in the State of California. In 1989 there were
two Medical Officer positions in the Cal/OSHA program.
Cal/OSHA, Decreasing Effectiveness Due To Staffing Level Failures
Cal/OSHA: Tiger Team Enforcement or Paper Tiger?
At present the Division has 193 field officers, covering compliance,
high-hazard industries, process safety management and mining and tunneling.
That is a ratio of one inspector for about every 91,191 workers and 6,100
workplaces. One or more of the top three leadership positions within DOSH
has been vacant for "significant periods" in the last several years.
Recently the vacant chief's post was filled by Len Welsh, who still has to
be officially nominated by the governor and confirmed by the state Senate.
That job was vacant for almost a year after the departure of John Howard.
The Division has had no deputy chief for health since 2000.
DOSH's "benchmark" for inspector staffing remains at l98, the level that
Fed-OSHA accepted in 1994. Previously the benchmark had been 805 inspectors,
based on a 1980 U.S. Court of Appeals decision in AFL-CIO v. Marshall. The
Benchmark constitutes the "fully effective" compliance staffing level of a
state program. OSHA had recommended to the court that California allocate
334 safety and 471 health compliance officers.
But in l993 the Department of Industrial Relations reassessed California's
staffing requirements and came up with a benchmark of 118 safety and 80
Whether or not the 805 benchmark ws ever realistic, the new benchmark has
remained static for almost 10 years while the number of workplaces has risen
21 percent and the workforce has increased 13 percent. The ratio of
inspectors to workers has declined 6 percent since 2001 - from 1:86,212 to
April 2003 California has more fish and game wardens than workplace safety
and health inspectors - 227 vs. 193.
See Chart 1 Staffing History, 1980 - Present
Chart 2 California vs. Western Neighborhoods, Nov. 2001