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records, but by examining the workers—that there was a very large number of these types of disorders at the Health Tex plants in Virginia which were not showing up. Why? Because the reporting system under the State worker Compensation laws in Virginia is very bad. Workers are required to go to the company doctor in Virginia. They don't have a choice of their own physician.

So the point is that there is a lot of illness out there that is not showing up, which requires a much more detailed investigation of the workplace now, and we don't have to wait 5 years to get those results. We need to send the people out there now and OSHA can, and the BLS can, if they want to, take along a physician who knows how to look for these kinds of medical records in a plant, their absence records, their health insurance records, and see whether those injuries or illness look to be work-related.

If we did that, we would stop having the national competition between States to see who could cut their worker comp law, to below subsistence levels, But instead, we have this universe of cases which is defined as what the employers tell us. Employers aren't going to tell us, and you know that, and all I am saying is we don't have to wait, a long time to go look at what is there.

Certainly if Dupont had looked at what was there in that Gibbstown, New Jersey, plant with their fine medical directors, they could have found it, but they consciously chose not to look at it. I suspect that that is not the only plant in the country where asbestos workers are being examined, are being found to be ill, and no one is telling them the truth.

Mr. FRANK. Let me ask now with regard to the reporting of occupational illnesses that NIOSH talked about, the fact that no occupational illnesses are now being nationally reported, and they are very happy that silicosis is about to be. That seems like a great inadequacy. Should more be done by the Federal Government just to kind of insist on that? Waiting around for these State agreements seems to me not to have produced very much.

What can be done to try and increase that reporting which would seem like a necessary step toward improving our ability to act in this area?

Ms. SEMINARIO. I wasn't here for NIOSH's testimony so-

Mr. FRANK. Well, what they said was that no occupational illnesses are now in that national reporting system. As a result of some conversations they have had with the Conference of State Epidemiologists, there is an agreement now that silicosis will become the first occupational illness reported, but there are obviously a lot of others and the pace at which the occupational illnesses are being added doesn't seem to be a very impressive one.

Ms. SEMINARIO. Allow me to just make a few comments and I think Mr. Frumin has a few additional ones.

The first issue is the identification of occupational diseases and I think NIOSH is correct in saying that we do have a problem with physicians recognizing occupational disease, which is one of the reasons why the workplace may not be the best source of information. At least if you have a situation where medical attention is directly related to workplace exposures, or you could make that association there is probably a better chance of identifying the disease because there is a consciousness of workplace hazards.

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Most of the doctors in this country don't have that awareness so even if you require all the physicians who happen to see a worker reporting a disease, it doesn't guarantee identification of occupational disease. Probably for certain diseases like silicosis, and other recognized diseases, such as mesothelioma, that kind of reporting should be required, but we do have a basic problem with the identification.

I think one of the things that we need to do is try to make a start in every area that we can. There isn't just going to be one reporting system, and while it would be nice to think about trying to get a program legislated that would require reporting-we still have these basic problems with identification. All the legislation in the world isn't going to take care of that particular problem.

Again, I come back to the point that we made, that in many of these cases, the information is there. It is in the medical records. It is just not being evaluated

Mr. FRANK. I appreciate that, but if you keep coming back to the points that you have made, we won't get into any other points and we are trying to get-

Ms. SEMINARIO. Fine.
Mr. FRANK. We are trying to look at several of these things.

Mr. FRUMIN. Let me follow up on Dr. Millar's comment that you asked about.

You know, there is an environmental disease which is currently, and for some time has been reported along with these other infectious diseases—and that is lead poisoning in children.

Ms. SEMINARIO. That is right.

Mr. FRUMIN. Now, the fact that it is reported now is due to a tremendous struggle that was waged by physicians and community residents, largely in poor communities, against the problem of lead poisoning in children. I don't mean to detract from their struggle at all, but it reflects the bias of the medical community and the medical establishment in the government, the National Center for Health Statistics and Centers for Disease Control, that when they asked for reports on lead poisoning, it should only be up to age, you know, whatever, age 12. The fact is lead poisoning, is a very serious problem for workers.

There is a lead standard that was finally issued in 1978 by OSHA and for good reason, because there are there are hundreds of thousands of—

Mr. FRANK. Excuse me. We don't have all morning-well, we don't have any morning left. I am trying to focus on what we can do to improve the situation. I understand that there are problems and

Mr. FRUMIN. Well-

Mr. FRANK. Mr. Frumin, I am going to set the ground rules for this hearing. I would like suggestions from you on how we can improve getting these done. I agree that more of these should have been reported.

Given your familiarity with the field, I am wondering if you have suggestions about how-I understand that there is bias or they would have been reported. Had there been no bias, we wouldn't have a hearing.

Now that we are here, the question is: Are there things we can do to try and make it better? We accept the fact that there is not now adequate reporting of occupational illnesses. The question is: What is the mechanism by which they can be done and are there things that we can do to get more of them reported? Which ones ought to be reported and how do we do it?

Mr. FRUMIN. Sure. As I mentioned in my testimony, OSHA has health standards out there now for recognized illnesses. It would take very little effort on OSHA's part to mandate that employers who identify workers who are sick, under those medical surveillance programs, report them to-and you can pick your agency. You can report them to NIOSH; you can report them to OSHA

Mr. FRANK. All right. That is exactly what I was looking forwhat authority OSHA has now-rather than having to wait and negotiate these with the State epidemiologists, OSHA could require that certain of these be reported to NIOSH.

Mr. FRUMIN. That is true, that is exactly true and they could all—for instance, OSHA already requires employers to report to them under some of the standards where they use the chemical-

Mr. FRANK. But that is only

Mr. FRUMIN (continuing]. Or emergencies or things of that nature.

Mr. FRANK. That is employers and we would like to have that, but more. What about other situations?

Mr. FRUMIN. Oh, there is no reason why the Centers for Disease Control couldn't say, “Well, let's add a lot more diseases, not just the dust diseases of the lung, which have been around for six or seven centuries," They could add various kinds of poisoning; that is the reason I mentioned lead poisoning. There are other kinds of poisoning from different toxic substances which are well known. Lead is the most

Mr. FRANK. Require that these be reported to

Mr. FRUMIN. To the Centers for Disease Control as partthrough the State health networks. That is true. You know, one of our goals in the labor movement has been to try to get the review of medical records moved away from employer-owned physicians for precisely this reason, because we are not getting any reports out of them.

Mr. FRANK. That is precisely why I said that we don't want to just sit back. Now the other question is, how do we do it more broadly?

You are suggesting that the CDC has got the power to add an effect to those nationally reported

Mr. FRUMIN. Well, it is a voluntary system but they have the functional power; they just don't have the authority. But let's also look at the Coal Mine Health and Safety Act, because as far as occupational disease in this country is concerned, it is the model. You can't get away from it. You can't ignore it. It is much too important. It broke the ground on occupational disease-

Mr. FRANK. It would help if you could focus a little

Mr. FRUMIN. Well, what that requires is that the physicians who do the exams, first of all, are not controlled by the employer, but more importantly, that the results of those exams go to NIOSH. NIOSH reads the x ray that every-on every coal miner whenever they are taken. Now, maybe we don't need something that ambitious because we are talking about a much larger group of workers here, but there is no reason why the results of those medical tests cannot be reported to NIOSH every time they are done.

Mr. FRANK. I am going to end my questioning here. I would appreciate it if you could give me in writing your specific suggestions for what we should do about reporting. Who ought to initiate this process—either the requirement or suggestion, depending on their legal power. You say OSHA can require this data from employers, CDC can request it from others—to whom should they report occupational illnesses.

Mr. FRUMIN. OK, but

Mr. FRANK. I think that is one very specific set of responses we need. We are running out of time.

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During my testimony, you requested a succinct itemization of measures which could be taken to improve the reporting of occupational injuries and illnesses in the U.S. Before I provide the listing, I would like to draw your attention to the exact nature of the problem, as I see it. What we need is not necessarily further large-scale scientific research on the extent of occupational injuries and illnesses throughout the country, although we certainly need considerably more research in this area. On the contrary, if we are truly interested in preventing these injuries and illnesses, we must ensure that those injuries and illnesses which are already known to exist are promptly reported to a central location. During the hearing, Dr. Millar of NIOSH eloquently stated the necessity for such a reporting sys. tem, as compared to conventional research projects, as part of an overall preventive effort, and I wish to second those comments.

It is also essential to point out that OSHA already has the authority under the Act to require such reporting when the injury or illness is identified by or brought to the attention of either a employer or a physician retained by an employer. Thus, despite Mr. Tyson's comments to the contrary, OSHA is al. ready deeply involved in questions of injury and illness reporting, and cannot simply escape its responsibility by labeling such reporting scheme's as "research."

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