Transcript Document 7184414

Employee Medical and
Exposure Records
Keeping and providing access to medical
and exposure records
November, 2010
This Module will cover the following:
The scope and purpose of the
rule – WAC 296-802
The specific retention periods
and requirements for medical
and exposure records, and
analysis
The process for accessing
identifiable medical information
Rule Scope
This rule applies to all employers who make, maintain,
contract for, or have access to employee medical or
exposure records, or analysis of employee medical or
exposure records.
All employee medical and exposure records are
included, whether or not they are required by specific
safety and health rules.
Note: “exposure records” are any records, data or measurements of employee
exposure to chemicals or physical hazards, or biological monitoring results
Rule Purpose
The rule fulfills 3 primary purposes:
To require the retention of medical and exposure
records related to employees exposure to toxic
substances or harmful physical agents.
To ensure access to records by affected employees,
designated representatives and DOSH.
To ensure employees are informed by their employers
of their right to access records, how records are
maintained and the procedures for obtaining access.
Related Rules
The following 3 slides provide information on
these related rules:
• Trade secrets
• Chemical hazard communication
• Material Safety Data Sheets (MSDS)
Trade Secrets
WAC 296-816, Trade Secrets
allows employers to withhold
trade secret information from
employee medical or exposure
records.
Employers may condition access
to trade secret information upon a
written agreement not to misuse
the information.
Chemical Hazard Communication
• The chemical hazard communication standard
requires manufacturers and importers to assess the
hazards of chemicals, label the containers with the
hazards and provide MSDS
• Employers must provide employees with information
on the hazards of chemicals
they are exposed to.
Material Safety Data Sheets
WAC 296-800-180, Material
Safety Data Sheets as Exposure
Records, establishes that MSDS
are a type of exposure record.
MSDS must be retained and
made available to employees,
their representatives and the
department as exposure records.
Other legal obligations
The requirements of this rule do not affect any
other legal obligations the employer has to keep
employee medical information confidential.
In general the employer contracts with a medical
provider to maintain employee medical records in
a confidential manner.
Medical Records Retention
Employee medical records must be retained for
duration of employment plus 30 years.
If a specific rule provides a different retention
period that retention period must be followed,
e.g. the lead rule requires that medical records
be retained for at least forty years, or for the
duration of employment plus
twenty years, whichever is longer.
Link to list of specific rule retention requirements
Medical Records (Cont.)
Retention Exemption:
• If an employee works less than one year the
medical record does not need to be retained as
long as the record is provided to the employee
• The following records do not need to be kept:
– Health insurance claims maintained separately
from the medical record
– Records of first-aid treatment, if made
on-site by a non-physician and kept
separately from the medical record
Exposure Records Retention
• Exposure records must be retained for
30 years from the date they were
created.
• If a specific rule provides a different
retention period that retention period
must be followed.
• For example the arsenic rule requires
that exposure records be retained for
at least forty years, or for the duration
of employment plus twenty years,
whichever is longer.
Specific employee medical & exposure records requirements
Exposure Records (Cont.)
All monitoring background data
does not need to be kept for more
than one year as long as a
summary of the data is kept for 30
years.
Individual exposure records
concerning the identity of a
substance need not be kept as long
as some record of the identity of
the substance, where and when it
was used, is kept for 30 years.
Analysis of Records
Analysis using medical or exposure
records must be kept for at least 30
years.
Employees must not be identified in
any portion of released analysis that
reports the contents of employee
medical records, e.g., names, social
security number, or other identifying
information.
Informing Employees about Records
• The following information must be provided upon
employment and at least annually:
– Where records are located
– Who is responsible for the records
– Who to contact for access
– Their rights to copy records
• The information must be made accessible, but
formal training is not necessary
Employee Access
The requirements of this rule apply to both
current and former employees.
Provide employees, or their representatives,
access to their records upon request:
– In a reasonable time, place and manner
– Within 15 working days of the request
– Provide a copy at no cost. A nominal
charge may be applied for additional
copies.
Employee Access (Cont.)
A physician representing the employer may
restrict access to health information regarding
a terminal illness or psychiatric condition if the
physician believes this information could harm
the employee.
The physician may recommend that this
information only be released to a
designated employee representative.
Employee Access (Cont.)
A healthcare professional maintaining employee
medical records may delete the identity of a:
– Family member
– Personal friend or fellow employee who has provided
confidential information concerning the employee’s
health status.
Employee Access (Cont.)
Provide requested exposure records for an
employee's current or transfer work assignment.
In the absence of records specific to the
employee, exposure records of other employees
with the same job duties or related working
conditions may be provided.
Written Authorization for Access
• Provide designated representatives access to
employee medical records when the employee
provides specific written authorization.
• If the authorization does not contain an
expiration dates it expires in 90 days.
• An employee may revoke the authorization at
any time.
Sample authorization letter to release medical information
DOSH Access Orders
DOSH may issue an “access order” when it is
necessary to obtain identifiable employee
medical information.
The rule specifies the contents of an access order.
WAC 296-802-500
An access order is not needed:
- For records that do not contain personal identification
information
- To verify compliance with medical surveillance
requirements of another rule
- To access records, such as medical opinions or
biological monitoring results, when required by another
rule
Record Transfer and Disposal
When an employer goes out of business:
– All records are transferred to the new employer
– If no other employer continues the business, current
and former employees may access the records, and
the employer must notify DOSH of intent to dispose or
transfer records to DOSH when required under rule
Questions & Answers
Q. Is post vaccination hepatitis B antibody testing
considered an exposure or a medical record?
A. Medical record because it measures a physiological
change.
Q. Would the inclusion of a job title in an analysis that
includes employee medical information be a breach of
confidentiality?
A. It could if there were a limited number of these
positions and the title could easily be used to identify
an employee or imply identification.
Q&A
Q. May the employer keep an employee’s tuberculin
skin test record in the personnel file?
A.
No, the skin test result is confidential medical
information. The employer or employer’s
representatives would not have access to this
record with specific written authorization.
Q. Does posting the OSHA 300A form constitute a
breach of confidentiality?
A. No, as it does not contain personally identifiable
medical information. There are few conditions that
must be posted as privacy cases and identifiers
removed, e.g., tuberculosis and HIV infection
Q&A
Q. What would be some reasons for DOSH to issue an
Access Order?
A.
- To document employer knowledge, or
- To document poor management of employees with
evidence of adverse health effects, or
- To verify compliance during follow-up inspections
Q.
May an employee request exposure records of
similarly situated employees?
A.
Yes, in the absence of personally relevant records
the employee may request records of other
employees who may have experienced similar
exposures.
Q&A
Q.
Must employers maintain records of treatment of
minor wounds as medical records?
A.
No, generally cleaning, flushing, or soaking
wounds, and the application of wound coverings is
considered first-aid.
Q.
Must the employer maintain exposure records
including the identity of a hazardous chemical?
A.
No, the identity may be retained either as part of the
exposure record or as a separate record.
Documentation of where and when the substance
was used must be included.
Q&A
Q.
Must employers retain medical records of short
term employees (employed for less than a year)?
A.
No, not as long as they provide the records to the
employee upon termination.
Q.
Must employers provide employees or their
representatives with the exposure records of all
employees with similar exposures.
A.
Not routinely, the rule only allows access to
records of similarly exposed employees when
employee personal records are inadequate.
Q&A
Q.
Does the employer have any protection against the
unnecessary disclosure of trade secrets?
A.
Yes, the Trade Secret rule, chapter
296-816 WAC provides these protections.
Q.
Are unions considered employee representatives?
A.
Yes, but only in regards to access to exposure
records. In order to access exposure information
unions must state which records they want
disclosed and the specific occupational health
need.
Other Questions?
Please contact:
Pam Edwards
DOSH Technical Services
360-902-6457
[email protected]