Finally, there are already reporting requirements under other laws concerning occupational injuries and illnesses, including most prominently the legislation on coal mine safety and the Toxic Substances Control Act, which provide ample precedents for greatly enlarged requirements in this area.

Bearing in mind these points, I suggest that the following measures be considered by the Subcommittee in its deliberations on this issue:

1) All occupational illness cases identified during employers' medical surveillance programs carried out under health standards issued pursuant to Section 6(b) should be reported to the local Federal OSHA Area Office (and to the state enforcement agencies in appropriate states).

2) All occupational illness cases known to employers (or their physicians), and believed to have occurred as a result of workers' exposure to any other "toxic substance or harmful physical agent" regulated by OSHA (which includes about 450 other chemicals or agents), should be reported to the local Federal OSHA Area Office (and to the state enforcement agencies in appropriate states).

3) OSHA should transmit such reports to NIOSH on a regular basis, with an understanding between the two agencies that one or the other will investigate the circumstances of the illness, in an appropriate manner.

4) NIOSH should continue to cooperate with state health agencies to encourage the reporting of occupational illnesses by physicians who are seeing patients independently of the patients' employers. The diseases covered by such a reporting system should include all those believed to have occurred as a result of exposure to any of the substances regulated under Section 6(b), as well as any other illness deemed appropriate by NIOSH and the cooperating state health agencies. Such reports could be submitted in the same manner as reports for other diseases currently covered by physicians' reporting requirements, namely, through the state health agency to the Centers for Disease Control (which includes NIOSH).

5) NIOSH should assure that the circumstances of all such cases, including the risk to other employees, are investigated in an appropriate manner. Where necessary, NIOSH should transmit the results of its investigation to the local federal OSHA Area Office (or appropriate state enforcement agency) in a timely fashion. NIOSH could also enter into agreements with appropriate state health agencies to conduct such investigations, provided that the results were transmitted to NIOSH and the enforcement agencies in an equivalent manner. During any such investigations, no illness reports should be transmitted to the employer over

the objection of the subject employee, unless otherwise required by law, as such reports would violate the employee's routine right to privacy in a medical setting.

6) All occupational fatalities known to physicians should be reported immediately by the examining physician to the state health department, which should immediately transmit such reports to the local OSHA Area Office (or the appropriate state enforcement agency) and, in a timely fashion, to the Centers for Disease Control.

7) The BLS should conduct a comprehensive Quality Assurance Program, in cooperation with NIOSH, to assure that the statistical methods used in the Bureau's Annual Survey are valid.

Such a program must make use of all medical records available to the employers studied, for the reasons described in my testimony. A program such as this will greatly enhance our knowledge about the problems encountered in establishing reporting systems for occupational illnesses, as well as for occupational injuries.

I hope these comments are useful to your Subcommittee. Please feel free to contact me if you have any questions regarding the above.

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Mr. FRANK. Mr. McKernan.

Mr. McKERNAN. I am going to be very brief and ask for basically the same thing that the chairman just asked for. I am interested in some of the allegations you have made about current policy at OSHA. I would like to have in writing from you, if I could, those things that you feel OSHA ought to be improving upon as it relates—don't worry, I am going to narrow thisas it relates to[Laughter.]

Ms. SEMINARIO. How long of a paper do you want?

Mr. McKERNAN [continuing). Occupational illnesses. OK. And understanding that what our interest is is not a harangue about the greed of employers and all this other stuff, but really what can we do to try to, s, identify those illnesses which have not been identified yet, and B, those which have to try to do something about it through better gathering of data.

So that what I hope to do with this information is then go back to OSHA and ask them why they are not doing whatever you say ought to be done and if they just keep pointing the fingers and perhaps that is an accurate description of the present system, is that everybody is pointing the finger because it is too diversified, I would like to at least be able to get what you think ought to be done and how it could be done, and then go back to them and go to NIOSH and say, "Why aren't you doing it?"

I guess—I know you have a longstanding feud with OSHA, but this hearing today, for me, has really brought out more of the inadequacy of NIOSH's activities than anything else. And there seems to be just a general, "Gee, this is great research, let's try to get as much information as we can. If it doesn't come in, well, that's the breaks. We will do whatever we can with what we have,” instead of taking a leadership position and trying to go out there and get the information that really is needed to finalize some additional standards perhaps.

Mr. FRUMIN. Let me respond by saying I think you have to be very careful about overstating the role of NIOSH in this. NIOSH doesn't have the authority to compel people to report to them in a regulatory fashion. If we are talking about setting up uniform recordkeeping systems, you have got to look at OSHA and the BLS, because when you, in your wisdom, passed this law in 1970, said that the Secretary of Labor shall establish, statistics systems, it was Secretary of Labor; it wasn't the Secretary of Health and Human Services.

I don't think we need to change that. What I think we need to do is to see to it that the Congress, reminds OSHA the Secretary of Labor that you were interested in having the BLS do something worthwhile.

That is why the quality assurance program, with respect to occupational illnesses-never mind injuries for a monent, I understand that is for a later day-with respect to occupational illnesses it is very important because we heard some misrepresentation this morning about how some of the recognized occupational illnesses are getting reported to the BLS and it is only these long latent ones that aren't being reported.

That is simply not true. The fact is that recognized occupational illnesses like cumulative trauma disorders, which you know,

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coming from the State of Maine, cost companies a lot of money and allegedly force them out of business. Mr. Chairman, you opened up this hearing with a comment on the cost of health care. Even those illnesses which are pretty obvious and are recognized by the doctors are not being reported to the BLS. The BLS and OSHA and NIOSH together, if we can get them to work together, heaven forfend—could in a quality assurance program identify the extent of the gap in our current knowledge and give them the basis and give you the basis for saying what are the areas, the directions we need to go to to change the situation?

Now, we need to do a little research to move ahead. It doesn't have to be something grand. We don't have to set up a new national institute. All we have to do is go out there and say, as this investigator did, what do we see happening there now that is not being reported and how is it not being reported and that is what the BLS Quality Assurance Program is supposed to do.

The fact is that the BLS has refused to say that they are interested in going beyond the OSHA-required records, and as long they do that, they define the universe; they will go out; they will find it; and they will say that nothing else exists. And they will never have, and you will never have, the information that you need to get a handle on those illnesses which are currently are described in records in the workplace—not illnesses that have to be found out anew, but are currently described

Mr. McKERNAN. Well, if you could just, as I said, put in writing for the committee

Mr. FRUMIN. We will be glad to do that.

Mr. McKERNAN [continuing]. Those things that you feel need to be done, need to be changed, and then we can go back to the people who testified before you and find out what their response is. I think it would give us a lot better idea of what really needs to be done and what our role ought to be in that.

[See pages 206–208.]

Mr. FRANK. Very good. I would suggest, Mr. Frumin, we will take-if you want to do it in two documents, the specific suggestions and an accompanying narrative, that might be the most useful form in which to have it.

Mr. Owens.

Mr. OWENS. I just want to piggyback off what both of you have said in terms of the statements made by the earlier witnesses seem to have amnesia about the degree to which OSHA has been involved in doing research and if you can pinpoint examples, I think that overlaps on what they asked for already-examples of where it was being done before and is not being done now. It will be very helpful.

Mr. FRUMIN. We would be glad to provide that. A lot of it is in our testimony already, but we would be glad to supplement that with a specific list of suggestions.

[See pages 206-208.)

Mr. FRANK. Thank you. I understand some of it is in your testimony, but you have heard some specific-

Mr. FRUMIN. Yes.

Mr. FRANK [continuing). Remarks from the agencies and so what we really need is to have it recast in those terms.

Thank you very much. The hearing is adjourned.

[Whereupon, at 12:20 p.m., the subcommittee adjourned, to reconvene subject to the call of the Chair.]

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