Copyright 2000 Federal News Service, Inc.
Federal News Service
July 13, 2000, Thursday
SECTION: PREPARED TESTIMONY
LENGTH: 2390 words
HEADLINE:
PREPARED TESTIMONY OF CHARLES N. JEFFRESS ASSISTANT SECRETARY FOR OCCUPATIONAL
SAFETY AND HEALTH U.S. DEPARTMENT OF LABOR
BEFORE THE
SENATE COMMITTEE ON HEALTH, EDUCATION, LABOR AND PENSIONS
SUBCOMMITTEE ON EMPLOYMENT, SAFETY AND TRAINING
SUBJECT - OSHA'S
PROPOSED ERGONOMICS STANDARD
BODY:
Mr.
Chairman, members of the Subcommittee, thank you for inviting me to testify,
about the Occupational Safety and Health Administration's (OSHA) proposed
ergonomics program and its possible impact on Medicaid, Medicare, and other
health care costs.
Introduction
Work-related musculoskeletal
disorders (MSDs) are the most widespread occupational health hazard facing our
Nation today. Nearly two million workers suffer work-related musculoskeletal
disorders every year and about 600,000 lose time from work as a result. Although
the median number of lost workdays associated with these incidents is seven
days, the most severe injuries can put people out of work for months and even
permanently disable them. The direct costs attributable to MSDs total
$15 to $18 billion per year, with indirect
costs (such as resulting management costs or the cost of production losses)
increasing the costs to employers to more than $45 billion.
In the health care sector, the Bureau of Labor Statistics reports that
there were nearly 90,000 MSDs resulting in days away from work in 1998. Almost
fifteen percent of MSDs in private industry occurred in the health care sector
-- largely in hospitals and nursing homes, and often due to lifting and moving
patients. In addition, witnesses at OSHA's public hearings representing
employees in sonography testified that as many as 75% of technicians doing
ultrasound suffer from MSDs. OSHA estimates that workers' compensation for MSDs
in the health sector cost $2.8 billion in 1996. with total
indirect costs estimated to be about $5.8 billion.
Real
People
The human dimension of this problem in the health care industry
is striking. Women. in particular, experience a high number of MSDs, because a
large number of women work in health care jobs - nurses, nurses aides,
orderlies, and attendants - associated with heavy lifting or awkward postures.
For example, Beth Picknick, a registered nurse working in an ICU unit,
suffered a career-ending back injury that was devastating, both personally and
professionally. Throughout her career, Ms. Picknick helped patients move from
their beds to chairs and back. Twisting, bending, pulling and pushing were all
part of the job. She never had any back problems. While helping to move a
patient, Ms. Picknick severely injured her back. Physicians, surgeons and
physical therapists were not able to relieve the constant pain. Finally, two
years after the injury., Ms. Picknick had spinal fusion surgery coupled with a
major rehabilitation program. She was willing to endure whatever pain it took to
return to the job she loved. Despite the surgery and the physical therapy,
however, she cannot return to her job. Nor can she participate with her family
in bicycling, racquetball, waterskiing or the yearly white water rafting trips
she used to enjoy.
Similarly, another nurse at another workplace
developed carpal tunnel syndrome in both wrists due to manually cranking beds
and pushing tables and shower chairs with bad castors. Sometimes she cannot feed
herself. She is on complete disability and awaiting four surgeries, one on each
wrist and one on each shoulder. She says that if the health care facility had
had proper equipment, this might not have happened. Workers like these are why
it is important for OSHA to issue its ergonomics regulation.
OSHA's Proposal
Ergonomics has its roots in improving efficiency
and productivity. For years, many employers have known that good ergonomics is
often good economics. And those employers have not only saved their workers from
injury and potential misery, but they have saved millions of dollars in the
process. OSHA has spent 10 years studying this issue, analyzing evidence,
reviewing data, talking to stakeholders, and discussing ideas and options. It is
now time to act.
OSHA's proposed ergonomics program standard draws on
the experience of companies that have implemented successful programs. The
proposed standard relies on a practical, flexible approach that reflects health
care industry best practices and focuses on jobs where work-related MSDs occur,
problems are severe, and solutions are generally understood. It would require
health care industry employers to address ergonomics for manual handling jobs,
where we know the problems are most severe. In other jobs, it would require
health care employers to act when employees report work-related MSDs.
Opponents of OSHA's proposed rule say it would have an adverse effect by
increasing the costs of services for patients who depend on Medicare and
Medicaid. To the contrary, I believe the benefits of ergonomics programs will
greatly exceed the costs, which will be comparatively small in the context of
total Medicare and Medicaid expenditures. Any potential costs will be more than
offset for the health care sector because the benefits of the standard will
likely far outweigh the costs. An ergonomics program standard can help hospitals
and nursing homes reduce Medicare and Medicaid expenses by improving the
productivity of health care workers through the reduction of costly injuries to
staff. For example, a standard portable device for lifting patients can be
purchased for $3,000. The average cost of back surgery,
according to Health Care Financing Administration (HCFA) data is
$16,072. And this figure does not include indemnity, payments
for the injured worker's lost time or replacement costs. In any case, OSHA
estimates that the potential costs of the ergonomics program standard to the
health care sector in 1996 would have been $644 million (in
1996 dollars) -- less than 0.2 percent of Medicare and Medicaid costs in that
year. These costs would not significantly contribute to growth in Medicaid and
Medicare costs. The annual costs of OSHA's proposed ergonomics program to the
health care sector -- even assuming no benefits from the standard -- represent
less than one percent of the projected increase in Medicare and Medicaid costs
from 2000 to 2005.
OSHA believes there is substantial evidence to show
that ergonomics programs can save workers' compensation costs, increase
productivity, and decrease employee turnover. MSDs are preventable, and there
are innumerable examples of health care employers who have succeeded in finding
different ways to protect their workers from sometimes disabling injuries. In
one study, a nursing home reduced lost workdays from back injuries by 50 percent
after implementing a comprehensive ergonomics program. Another nursing home
reduced lost workdays by 89 percent after its employees began using
patient-lifting devices. One hospital reduced back injuries by 94 percent and
significantly improved nursing productivity by having a trained-lift team
perform 95% of all patient lifts. These types of ergonomic solutions in the
health care industry are not new, nor are they limited to the United States. The
United Kingdom has implemented a general policy of eliminating hazardous manual
lifting of patients except in life- threatening situations.
I have
attached to my testimony a chart that lists dozens of health care providers
across the United States who have implemented successful ergonomics programs. In
the State of Maine, hospitals and nursing homes as well as home health care
providers have reduced MSDs and related costs by implementing ergonomics
programs.
For example, the Kennebec Health System of Augusta, Maine,
reduced annual lost workdays from 1,097 to 48 after it implemented an ergonomics
program and began using lift-assist devices. As a result, their insurance
premium fell from $1.6 million annually to
$770,293 - a cost savings of more than
$800,000. Another health care system, Sisters of Charity Health
System in Lewiston, Maine, reduced its workers' compensation costs for
work-related MSDs by about 30 percent between 1994 and 1996 after introducing
and implementing patient- lifting equipment. A nursing home, St. Joseph's Manor
Inc. of Portland, Maine, reduced their total occupational injuries and illnesses
by 40 percent after implementing an ergonomics and safe- lifting program. And
home health care providers such as Androscoggin Home Health Services in
Lewiston, Maine, cut their workers' compensation costs by 50 percent after
emphasizing safe-lifting techniques and back biomechanics.
The
successful ergonomics programs and experiences of these health care providers
are not an isolated occurrence, according to the hearing testimony of Mr. Carl
Siegfried, of Maine Employers Mutual Insurance Company (MEMIC), the state's
largest provider of workers' compensation insurance. Mr. Siegfried testified at
the hearing on the proposed ergonomics rule that his insurance company
represents all kinds of health care providers. None of the providers they insure
have found ergonomics programs and controls to be unsuccessful or infeasible and
none have been driven out of business. Moreover. Guy Fragala, Director of
Environmental Health and Safety at the University of Massachusetts Medical
School. testified that a stud,,' done by MEMIC "demonstrated a drop in medical
and indemnity costs from lifting injuries from $75,000 in 1993
to less than $5.600 in 1997." This drop followed the
implementation of an Ergonomic Management Program with a "no manual lift" policy
as the program's cornerstone.
The success of ergonomics programs and
controls is not limited to Maine providers. I would like to highlight a few more
of the success stories here: University Nursing Center of Enid, Oklahoma cut the
rate of work- related MSDs by 75 percent from 1996 to 1998 and reduced lost
workdays by more than 85 percent through its ergonomics program. In just two
years, an ergonomics program at Lovely Hill Nursing Home in Pawling, New York,
led to a 75 percent decline in the lost-time injury and illness rate and a
reduction in days lost to MSDs from 287 to 37. Between 1995 and 1997, Hallmark
Nursing Centre in Troy, New York. lowered their annual rate of total lost-time
injuries and illnesses from 23.5 to 9 after implementing an ergonomics program.
Between 1994 and 1998, after putting into place a safety and health program and
an ergonomics program, ergonomic-related back injuries at Citizens Memorial
Hospital in Bolivar, Missouri, decreased from 20 to 3. Citizens estimates that
it has saved $300.000 per year as a result. From 1995 to 1997,
Delmar Gardens North, a Florissant, Missouri, nursing care
facility...implemented an ergonomics program and reduced by 50 percent the rate
of back injuries among its staff nurses aides and the lost workday rate
associated with those injuries. North Village Park, a nursing care facility, in
Moberly, Missouri, bought new lifting equipment and reduced the number of lost
work days from 473 in 1995 to 16 in 1997. Sunnyrest Health Care Facility in
Colorado Springs, Colorado, reduced their rate of workplace lost-time injuries
by 75 percent between 1996 and 1998 after improving their ergonomics program by
adding patient-lifting assists to reduce the risk of injury, associated with
resident transfer. After putting an emphasis on their ergonomic-lifting safety
program, Laurel Center in Harrisburg, Pennsylvania, reduced their rate of
ergonomic-related back injuries by more than two-thirds in 1999.
These
successful programs show that ergonomics programs like those to be implemented
by employers under OSHA's proposal often reduce costs rather than increase them.
Many employers with successful ergonomics programs have included the same basic
elements in their programs that you will find in our proposal: They look at the
jobs where employees are getting hurt or reporting pain. Where they find a
problem, they fix the jobs in a way that is appropriate to their workplace.
Knowing that early intervention saves money and preserves health, they make sure
their employees receive early and effective medical management and pay attention
to recommendations for light duty or other measures. They train employees on how
to use patient lifting devices and other good patient transfer procedures.
Finally, they evaluate their ergonomics programs to see what is working and what
may still need improvement.
Some commentors also have expressed concern
about the proposed standard's potential effects on the rights of patients and
nursing home residents. A number of nurses and nurses aides testified at the
OSHA ergonomics hearings that most patients welcome the use of patient-lifting
devices because it makes them feel more secure and reduces their fear of falling
or being dropped. These workers also told OSHA about patients suffering skin
tears, broken hips, and shoulder dislocations when there are slips or falls
during manual lifting procedures. One nurses aide noted that occasionally
patients have been reluctant to use lifts, but that after someone speaks with
them and demonstrates the enhanced safety that is provided for them and for
staff. the patients prefer the lift. Hospitals and nursing homes that use
patient-lifting devices have found them safer and more secure for patients and
have found that few, if any, patients refuse them. In any case, while the
employment of patient-lifting devices is very effective in reducing ergonomics
hazards, there are other means of complying with the proposed standard, such as.
trained manual lifting teams. I can assure you that OSHA will work with
employers to ensure that patients' rights are respected. OSHA will not issue
citations where a patient refuses the use of a mechanical lift and the employer
provides other means of complying with the standard.
Conclusion
Since March, we have held nine weeks of public hearings across the
country in Washington, D.C., Chicago, Portland, Oregon, and Atlanta. We've heard
from more than 1,000 witnesses, and we've received more than 7,000 public
comments -- many from the medical community - on our proposed standard. We are
continuing to evaluate all that we've heard and all that we've read. But to my
knowledge, the evidence is overwhelming: Ergonomics is good business in the
health care industry, just as it is in the rest of general industry.
Mr.
Chairman, thank you for this opportunity to provide the Subcommittee with
information on OSHA's ergonomics proposal. I will be happy to respond to any
questions.
END
LOAD-DATE: July 18, 2000
