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  • ACOEM Comments on Proposed OSHA Rulemaking for Improved Tracking of Workplace Injuries and Illnesses

    The Honorable David Michaels
    Assistant Secretary
    Occupational Safety and Health Administration
    U.S. Department of Labor
    200 Constitution Avenue, N.W.
    Washington, D.C. 20210

    Re: Re: Comments on OSHA Docket No. OSHA-2013-0023; Improve Tracking of Workplace Injuries and Illnesses, Supplemental Notice of Proposed Rulemaking (79 Fed. Reg. 47605, August 14, 2014)

    Dear Dr. Michaels:

    The American College of Occupational and Environmental Medicine (ACOEM) appreciates the opportunity to comment on OSHA’s Supplemental Notice of Proposed Rulemaking (SNPRM), Improve Tracking of Workplace Injuries and Illnesses (79 Fed. Reg. 47605, August 14, 2014).

    ACOEM, an international society of more than 4,000 occupational and environmental physicians, provides leadership to promote optimal health and safety of workers, workplaces, and environments. Our medical specialty, occupational and environmental medicine (OEM) is devoted to prevention and management of occupational and environmental injury, illness and disability, and promotion of health and productivity of workers, their families, and communities.

    For nearly 100 years, ACOEM has served as a leading voice in the United States for improved health and safety in the workplace, and a key part of our advocacy has centered on the need for accurate data and recordkeeping of work-related injuries and illnesses. We believe the collection of workplace health data is fundamentally linked with the development of sound health care policies and more effective medical treatments.

    As we said in our March comments on the Notice of Proposed Rulemaking and we reiterate now — OSHA’s proposal comes at a time when the American workplace is increasingly focusing its attention on employee wellness, health promotion and productivity. Due to health care reform, patient-physician and employer-employee relationships are (or soon will be) experiencing major changes. In this environment, policies are needed that will help ensure that our new national awareness of the importance of good health in the workplace continues.

    As we address the need for such policies, we believe it is increasingly important to integrate wellness with safety in the workplace. The relationship of safety to overall well being in the workplace is being confirmed by new studies and initiatives, and thus we believe that proposals to improve safety can help employers as they strive to promote better health among their workers.

    ACOEM’s advocacy is aimed at ensuring that workers’ health and safety is optimized and that health policies impacting workers – whether created by employers or the government — are well conceived and fairly and effectively implemented.

    In response to the SNPRM, ACOEM invited members to comment on several of the questions OSHA asked in the Federal Register notice. Although those who responded do not represent a statistically accurate sample, their comments help to inform ACOEM and we believe help to inform the current rulemaking.

    Within the ACOEM membership, experiences are varied with respect to injury and illness reporting. Members report that in some workplaces, injury reporting may be inaccurate. As we said in our March 10, 2014, response to the NPRM, we believe that establishment-specific and open public-reporting of injury and illness data may lead to under-reporting of this data to avoid being “targeted” by OSHA and to avoid damaging public reputation essential to attracting employees and business. The desire to avoid reputational harm and OSHA inspections may create further pressure by some employers on occupational medicine personnel to downgrade the severity of their diagnoses and withhold appropriate treatment.

    We asked our members if the fact that employer injury and illness statistics will be publically available on the Internet could cause some employers to discourage their employees from reporting injuries and illnesses. Many ACOEM members agreed that underreporting could indeed be a result.

    Many members reported that they are aware of situations where employers have discouraged the reporting of illnesses and injuries. A common theme was that bonuses or incentives for a certain number of “injury free days” could lead to peer pressure upon an employee not to report.

    While most ACOEM members were not aware of employer practices to take adverse action against persons who report injuries or illnesses, they were aware of situations in which an employee decided not to report because of a fear of a potential adverse reaction.

    We suggest several specific steps to increase the likelihood of validity and reliable maintenance of the OSHA log:

    • Further increase medical record audits to assure accurate recordkeeping and reporting. 500 audits a year are insufficient to assure compliance.
    • Provide an electronic tool for employers to self-check their submitted information for recordkeeping errors and for deviance from industry averages.
    • Increase penalties for willful under-reporting, and/or safety incentive programs that discourage employee reporting.
    • Encourage employees, unions, physicians, and other members of the public to report patterns of willful under-reporting and publicize whistleblower protections. 
    • Further increase the number of targeted inspections of companies deviating (positively or negatively) from the industry-norm incident and DART rates.
    • In addition, the Recordkeeping Standard itself deserves review to better reflect current employment trends and medical practice. Large swaths of workers are not currently covered by the recordkeeping standards. The dramatic increase of the “contingent” workforce must be recognized, especially given some evidence that they may be particularly at risk of exposure to high hazard jobs. As a part of this effort, OSHA should re-evaluate the definition of “first-aid” to reduce the likelihood that necessary medical care is being withheld to avoid a “recordable.”
    The foundation of any improvement in understanding the true burden of occupational disease and injury in the United States begins with accurate recordkeeping. Any improvement in reporting achieved by the proposed rule will be undercut if the OSHA log retains language or standards that encourage invalid responses.

    We offer our assistance to OSHA as its rulemaking process continues, and again thank you for the opportunity to contribute.


    Kathryn Mueller, MD, MPH, FACOEM