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Federal Document Clearing House
Congressional Testimony
July 13, 2000, Thursday
SECTION: CAPITOL HILL HEARING TESTIMONY
LENGTH: 3067 words
HEADLINE:
TESTIMONY July 13, 2000 CHARLES ROADMAN II, PRESIDENT & CEO AMERICAN SOCIETY
FOR HEALTHCARE HUMAN RESOURCES SENATE HEALTH, EDUCATION, LABOR
& PENSIONS ERGONOMICS AND HEALTH CARE
BODY:
July 13, 2000 Charles Roadman II President, CEO Statement of the American
Society for Healthcare Human Resources and the American Hospital Association for
the Committee on Health, Education, Labor and Pensions Subcommittee on
Employment, Safety and Training of the United States Senate The American Society
for Healthcare Human Resources Administration (ASHHRA) and the American Hospital
- Association (AHA) are pleased to submit our statement for the record on the
impact of the Occupational Safety and Health Administration's
(OSHA) proposed ergonomic standard on health care providers. ASHHRA
represents nearly 2,500 individual human resource health care professionals and
the AHA represents nearly 5,000 hospital, health system, network, and other
health care providers. Health care organizations are in the business of caring
for people, and to do that right, we depend on individuals to tend to the needs
of our patients 24 hours a day, seven days a week. Because of this, patient and
employee safety is a primary concern for hospitals and health care providers. We
work diligently to ensure a safe work environment for all employees. However,
the AHA and ASHHRA are extremely concerned about the potential adverse impact
that OSHA's proposed ergonomic standard will have on hospitals.
Almost every position in a hospital would potentially fall under the aegis of
the proposal - nurses, physicians, orderlies, transporters, storeroom workers,
dieticians, and operating room staff, to name a few. The science of
musculoskeletal disorders (MSD) is new, and measures to determine and remedy
MSI)s are simply not yet known. Additionally, we believe that
OSHA's current ergonomics proposal is unworkable in its current
configuration in hospital and health care settings and could jeopardize the
ability of hospitals to provide quality patient care. HOSPITALS'FINANCIAL
SITUATION Indicators of hospitals' overall financial health are signaling
trouble now and in the future. The Balanced Budget Act of 1997 (BBA) reduced
Medicare payments for hospital inpatient services for fiscal years 1998 - 2002
by more than $70 billion - about $20 billion more in reductions than anticipated
at the time the law was enacted. Earlier this year, the Medicare Payment
Advisory Commission presented data to Congress showing hospital total margins on
the decline from their historic 5 to 6 percent level, reaching a low of 2.9
percent in 1999. And these financial pressures are occurring before the full
force of the BBA has been exerted. More than 75 percent, or nearly $18 billion,
of the BBA's hospital inpatient cuts fall on hospitals in 2000 to 2002. Private
sector payment restraints have further exacerbated hospitals' deteriorating
financial condition. In addition to the adverse impact of the BBA on hospitals,
the cost of government regulations and improved patient care through new
technologies have pushed hospitals' costs higher. The Administration estimates
that the privacy requirements included in the Health Insurance Portability and
Accountability Act (HIPPA) will increase costs for providers and plans by $1.2
billion for the first year alone, and $3.8 billion over five years. The
administrative simplification requirements of HIPPA will increase net cost by
$71 million annually. Hospitals and health care organizations will now be faced
with having to absorb additional costs associated with the implementing
OSHA's proposed ergonomics standard.' By
OSHA's own definition, "A standard is economically feasible if
industry can absorb or pass on the costs of compliance without threatening the
industry's long- term profitability or competitive structure." However, health
care providers are heavily regulated on the federal and state levels, and we
cannot pass these costs on to our consumers - our patients. And the additional
costs are not reimbursable under the Medicare program. The combined affects of
the BBA and other regulations can be seen in health care organizations across
this country, as we are faced with the difficult decisions of losing money or
discontinuing some vital services. Simply put, we cannot pass the costs on and
we are unable to absorb the costs associated with OSHA's
proposed ergonomic standard. PROPOSAL LACKS SCIENTIFIC EVIDENCE We are concerned
that OSHA's proposal lacks scientific evidence and would cost
health care providers millions of dollars without proof that it will ensure the
prevention of serious injuries. In fact, the scientific community is unable to
come to a consensus about what causes repetitive stress
injuries and what are its proven remedies. Scientific and medical journals have
published numerous conflicting studies. OSHA's proposed
standard would require health care employers to remedy a problem when there is
insufficient information to identify effective remedial steps. The proposed
ergonomics standard requires employers to complete a job safety analysis when a
single MSD is reported. But a job safety analysis is meaningless since the
alleged MSD may be common to other life activities. Many off-the-job activities
involve the same force, awkward postures, contact stress, repetition, static
postures, etc., that are alleged to cause work-related injuries. The proposed
standard fails to clearly define what "repetitive" means. At the University of
Chicago Hospitals, job-related exertion injuries have been reported for almost
any conceivable repetitive motion. In addition to patient lifting and material
handling, employees have reported exertion injuries as a result of stooping down
to pick up a pencil or going to the bathroom. Other reported cases in include:
long periods of walking, .reaching for files, sweeping the floor, using a
telephone, performing surgery for multiple hours, pulling garbage bags, and
doing other normal duties. Even very limited daily .keyboarding has been
reported to cause worker discomfort and MSD symptoms. Back, neck and shoulder
pains are difficult to independently verify by a medical professional.
OSHA's proposal implies that every worker complaint is
work-related and thereby justified. Under the standard, a report of a single MSD
must be followed up and the alleged conditions must be eliminated. There is very
little provision to allow for professional and managerial judgment. Currently,
it is hard to determine if a work- related exertion injury is caused by a work
hazard, a pre-existing condition, or other non- work-related causes or
activities. For an employer, it is difficult and very costly to dispute an
alleged work-related MSD symptom. The following two examples, illustrating these
points, are actual cases from hospitals in the Northwest. Our first example
involves a cook who is employed at one of our organizations and who has had
carpal tunnel surgery on both wrists. While some of the tasks involved in her
job, stirring pots, for example, may have caused pain, it is also likely that
these activities did not cause the injury. This employee's hobbies are
needlepoint and crocheting. She participates in these activities continuously in
the evenings, weekends, and even on break at the workplace. Carpal tunnel
injuries are caused by repetitive motion more akin to her hobbies than to her
duties as cook. In a second example, a clerical worker is cross-trained to do a
variety of activities, including cashiering, switchboard, patient financial
counseling and filing. This employee is also an avid fly-fisher. She had rotator
cuff surgery on her shoulder under worker's compensation. Her injury occurred
when she reached into a file cabinet. While in both of these examples the
symptoms may have manifested in the workplace, one could also argue that the
actual causes of the injuries could be traced to non-work activities. COSTS OF
OSHA STANDARD IS GROSSLY UNDERESTIMATED OSHA
estimates that implementing the ergonomics standard will cost about $150 per
affected job, and on average it will cost employers $900 total. We believe that
these costs are grossly underestimated, considering the size of many health care
organizations. When we discuss ergonomics in hospitals or long- term care
facilities, we think first of nurses and nurse aides and the back injuries that
may result from moving patients. On- the-job lifting injuries account for the
largest proportion of workers' compensation costs. At an estimated cost of $150
per affected job, the $900 per organization would amount to correcting" the jobs
of only six nurses, a small fraction of our employee workforce. And here's why.
In the ideal world, health care providers would eliminate almost all patient
lifting. Ceiling mounted patient lifting devices and track systems would be
installed in patient rooms, in operating suites, and every area where patient
lifting may be necessary. In addition, every cart, bed, stretcher or other
material transport device would be mechanized. The cost of one ceiling hoist is
between $5,000 and $10,000. For a large hospital of 500 beds, for example, the
equipment cost would be between $2.5 million and $5 million. The cost of a
stretcher retrofit is $4,000. If I 00 stretchers were retrofitted the cost would
be $400,000. Additional transport devices to be mechanized would be patient
beds, food carts, OR case carts, materials supply carts, linen carts, and
trash/hazardous waste carts. In addition to the initial installation,
considerable cost is anticipated to maintain the equipment, and after all of
this is done, we still cannot ensure that all lifting will be eliminated. We
cannot predict when and where patients must be lifted in emergency situations.
We also cannot predict the condition and weight of the patients we serve. We can
predict, however, that trends such as increasing weight of the patient
population, more emphasis on intensive care, and the aging population will have
an impact on the number of exertion injuries we see. None of this will ever
prevent health care organizations from providing high-quality care in any
situation. But, OSHA's proposal will impose drastic costs not
reimbursable through the Medicare program, and reflects a lack of understanding
about how health care providers truly function. CONCLUSION OSHA
already requires that most work-related injuries be reported, tracked and
followed. The OSHA General Duty Clause and other regulations
provide venues for OSHA to enforce incidents where there is a
proven causal relationship between the injury and the work hazard.
OSHA's proposed ergonomic standard will go beyond the
requirements of the General Duty Clause, which states: "Each employer shall
furnish to each of his employees employment and a place of employment which are
free from recognized hazards that are causing or are likely to cause death or
serious physical harm to his employees." Employee safety is a primary concern
for hospitals and health care providers. We take seriously the requirements of
the General Duty Clause and will continue to support and follow the directive,
as good employers should do. However, because of the lack of scientific evidence
to support OSHA's ergonomic standard and the enormous financial
impact to health care organizations associated with implementing it, we urge
OSHA to withdraw its proposal.
LOAD-DATE: July 28, 2000, Friday
