Last Ca-OSHA Doctor Dr. Larry Rose exposes Attack On Program by Governor Brown

KPFA Morning Mix With The Last Ca-OSHA Doctor Dr. Larry Rose
http://archives.kpfa.org/data/20110330-Wed0800.mp3
at 21.43 minutes

The 28 year experiences of the senior Public Health Medical Officer at Cal OSHA And the Decline Of The Agency

(Larry Rose M.D., M.P.H. recently retired is on the clinical faculty of the UCSF Occupational/ Environmental Medicine, and was the senior PHMO in the Medical Unit of Cal-OSHA for 28 years)

Initially there were 5 Public Health Medical Officers, and 3 Nurse Consultants functioning at Cal-OSHA in 1975. This number of staff positions gradually faded by cutting positions, until 5 years ago when the last Public Health Medical Officer retired 4 years ago. That ended the presence of a public health physician at Cal-OSHA. Since then the agency has relied on corporate physicians for any of the many critical functions previously carried out by the Medical Unit.
Over the 30 years while functioning in the Medical Unit there were many instances of repression, and suppression of critical public and employee health information that the Medical Unit carried out. 'Starting with the Deukmajian administration the repression of the Medical Unit severely increased.
Political decisions were repeatedly made regarding investigations where the enforcement decisions were made primarily through a review of the medical records, and interviews with on site employees. These critically important investigations included: indoor air quality biologic and chemical contaminants, infectious diseases (tuberculosis AIDS, HIV, molds, pesticides, construction chemicals, etc.), cancer clusters, pesticide poisoning clusters, production line repetitive strain/carpal tunnel injuries, reviewing doctors first reports, reviewing new chemically induced serious illnesses.
During the 28 years of Medical Unit functioning any attempts to publish these findings in peer reviewed medical journals by members of the Unit were not allowed after these investigations were completed and supposedly open. The medical unit was not allowed to have any authority in determining the outcome of the above investigations.
. There were many instances where where the Medical Unit issued "Special Orders", "Medical Surveillance Orders" or "Orders to take special Action" to protect employees when there was no adequate protective "Standard". The political appointees repeatedly squashed these mandated Medical Unit attempts to protect employees in many California workplaces.
During this 28 year time period there were repeated instances of harassment, threats, punitive transfers, and repressive threats to abolish these Medical Unit positions.
It has been well established that certain occupations are at much greater risk of cancer and other diseases. Any attempt to obtain the long term medical records that these offending industries must retain was blocked by the present Cal-OSHA administration. In fact some of these industries were given special awards for excellence in health and safety programs by this agency administration.
One recent example of the malfeasance of this Len Welsh administration is the way he proceeded with the deaths and lung destruction of employees exposed to diacetyl. He used an industry physician to white wash the devastating air exposures to this very dangerous ubiquitous food compound. This chemical therefore has very serious public health implications for consumers of these food products.
Now Len Welsh, Cal-OSHA Chief, is using the DOSH investigators to threaten overworked professional employees with an investigation of their outside professional activities. These DOSH investigators are suppose to investigate instances of serious cases of workplace injuries, illness, and deaths, and not the outside activities of their professional coworkers. This is a typical perversion of Cal-OSHA professional staff by a political appointee (Mr., Len Welsh).
Over the past 30 years Cal-OSHA has switched its mission from enforcement to protect all employees in all California workplaces, to one of voluntary compliance by many large corporate workplaces. This has been accomplished through
DOSH enforcement understaffing, repressive edicts, consorting with industry, and downgrading all compliance enforcement activities. This direction must be turned around for the safety and welfare of all California working people.

Diminishing Performance and Effectiveness at Cal-OSHA

There are over 17 million workers in California. The total number of active inspectors that are enforcing the health, and safety regulation are at present 187.
The present ratio of actual inspectors (187) to workers (17,219,000) in California is 1 inspector to 92,080 workers (1:92,080). California is a state run program. Compared to other state run programs like Washington, and Oregon: 1: 26,904, and, 1: 22,239 respectively, this California inspector to worker power ratio is woefully inadequate, and compared to the British Columbia, Canada, provincial plan (1:10,564), it is a worker health and safety rights disgrace. The International Labor's Organization's inspector to worker guideline ratio for developed, industrial countries is 1: 10,000.

The trends at Cal-OSHA show a shocking decrease of 32% in the number of on-site inspections, and the number of cited violations over the past 14 years. This alarming trend correlates with the steady deficiencies in the ratio of the number of functioning enforcement inspectors to the total number of employees in the entire State of California.
The insufficient numbers of inspectors has led to failures by Cal-OSHA to meet the inspection requirements in the labor code: inspections are not being opened within the required 14 day post complaint period, inspections are not being closed in a timely fashion, many serious complaints are being declared "invalid" at the discretion of the 21 district managers (many of whom are safety inspectors), followup inspections for serious citations are not being done, there is less verification of abatement or correction of cited hazards, and there are weakened defenses of legal appeals by employers. In addition existing internal programs e.g.. targeted inspections in "high hazard industries", and in process safety management are short changed, and a concomitant reduction in previously programmed inspections in agriculture, construction, garment, and restaurant industries has occurred.
The health enforcement functioning of the statewide program has been essentially eliminated. At the inception of this state run program there were 6 public health medical officers, and several occupational health nurses enforcing health standards. The last public health medical officer position was abolished two years ago. This is of enormous importance in protecting California's work force from a multiplicity of hazardous chemicals, infectious diseases, and repetitive strain motion injuries. At present there are only about 80 functioning well trained health inspectors. These Industrial Hygienists are college level professionals primarily trained to measure various hazardous exposures and to apply mandated exposure limits when issuing violation citations.
There is an enormous problem with the inability of the existing health standards, and explicit exposure limits as set through the labor code to address all of the true workplace induced illnesses. Serious acute, and chronic long term illnesses are frequently caused by multiple chemical exposures, new technology industrial exposures (nanotechnology, genetic engineering, biotechnology), indoor air quality, infectious diseases, new chemicals, and pesticides, and an increasing proportion of the public becoming environmentally sensitive.
The Labor code did address the above problems, and therefore Cal-OSHA has the legal authority to establish relevant policies and procedures. The required strict recording of all occupational illness, the retention of all medical records for 30 years, doing medical surveillance with certain highly hazardous substance exposures is a important part of this program for worker protection.
There has been a serious problem with employers not recording an enormous proportion of occupational illnesses by setting it up so that most of them are only in need of first aid, and staying at work, or returning to the work place the next day, and therefore exempt from the official recording sheet.

The Tip of the Iceberg Examples.

There have been recent dramatic shocking examples of the tragic failure of Cal-OSHA to effectively respond to serious deaths and or life threatening illnesses.
1) The new biotechnology corporations that are developing microorganisms as pesticides caused a life threatening illness in a professional employee that was recognized by primary care medical practitioners as a laboratory workplace induced illness. The Cal-OSHA investigator assigned to Agriquest totally failed to address the problem that also threatened the surrounding community, and issued only a "laboratory hood" citation. The real issue was the level of laboratory protection needed ( probably Level 4) that should have been required for this production line laboratory. The same protection level as would be required for anthrax. This also would deeply question the safety of the microorganism product of this corporation. Industrial Hygienists are not trained in infectious disease control.
2) New chemicals that have been released and have become part of the 80,000 chemicals that are now in commercial circulation that have not been adequately tested for general public health safety. Only 15% of these chemicals have been barely adequately tested. Usually workers exposed to these untested chemicals are the equivalent of the "canary in the coal mine".
The recent shocking example of "popcorn lung disease" is a good example of a worker "body count" occurring and alerting the worker and public health community to the dangers of a particular hazardous chemical. Of course the illness should have been called "chemical lung destruction disease". Diacetyl is used in processed food and beverages as an additive to give a buttery taste. It is part of the oily substance chemical mix that is put on commercial popcorn. A worker at the Foothill Ranch flavor manufacturing facility had been exposed to the heated fumes, and over a period of a year and a half developed devastating lung destruction called "bronchiolitis obliterans", and 80% of his lung function was destroyed to the point that only a lung transplant offered any life saving hope. This workplace was incredibly cited over 6 months after the diagnosis, and then only $40,000 was the penalty for the destruction of a life, and the employer failed to report the illness. This fine was legally appealed. Nationally there were many more worker cases of lung disease reported from this exposure, and one documented case occurred in a consumer. It makes one wonder about the popcorn fumes that young theater workers are constantly exposed to.
The Cal-OSHA response was to have an industry physician associated with the Food and Extract Manufacturers Association do the medical screenings, and evaluations at the 20 plus workplaces. They were uncertain whether or not these comprised all of the industrial users of diacetyl in the state.
The chemical manufacturers of diacetyl were not required to provide a list of all of the firms they supplied with diacetyl in California. AB 816 that would have required that this information be provided by chemical manufacturers in California, but Governor Arnold Schwartzenegger vetoed the bill declaring it an "invasion of privacy".
The Cal-OSHA response as dictated by the governor's political appointee (Leonard Welsh, Acting Chief of Cal-OSHA), was to send in the non-enforcement component of Cal-OSHA called "Consultation" to this incomplete list of twenty odd industrial users of diacetyl.
An interesting side light to this is that Mr. Welsh has developed an ever expanding emphasis on so called "voluntary compliance" for the large corporations eg. IBM in California where they become essentially exempt from compliance investigations despite their use of many hazardous chemicals.
3-Another example of Cal-OSHA incompetence is the ongoing increasing deaths from hyperthermia in agricultural. Another example of the agricultural field worker heat stress prevention requirements being under enforced.

Addressing the Cal-OSHA Enforcement Disaster

The insufficient level of enforcement staffing plus the elimination of all Public Health Medical Officers has lead to a inability of the agency to meet the mandated responses to workplace health and safety as enumerated in the California Labor Code.
In 1975 the statewide program had 6 medical officer physicians, and three nurses functioning in enforcement and a much higher ratio of inspectors to workers. In 1975 Cal-OSHA was the strongest state OSHA program in the country. It is now one of the weakest programs despite the increasing numbers of hazardous industries in the state.
In 1980 the U.S. Court of Appeals decision in AFL-CIO v Marshall, the established benchmark had been 805 inspectors. OSHA has recommended 334 safety, and 471 health compliance officers. Instead under successive Republican California administrations the enforcement staff numbers have shrunk to the point of almost non-existence.
If an effective committed administration were operating, thirty vacant field positions would be hired and trained on an emergency basis, and five times as many inspectors plus 5 physician medical officers would be presented to the legislators as urgently needed to accomplish an effective Cal-OSHA. Anti-labor administration policies, plus weak statewide labor support have contributed to this dysfunctional Cal-OSHA picture.

The Privatization/Destruction Of CA-OSHA-Medical Services Being "contracted out"

by Dr. Larry Rose
larryrosemd [at] sbcglobal.net
Last medical doctor employed by California OSHA program

The California Labor & Workforce Development Agency has just decided to abolish the only physician position left in the Cal/OSHA Medical Unit. This will leave Cal/OSHA with one registered nurse in southern California and no DOSH medical personnel in northern California.
The present Acting Chief of Cal-OSHA, Len Welsh, has recently stated there was "long standing dissatisfaction with a physician in the Medical Unit who has since retired."Actually Dr. Larry Rose M.D.,M.P.H. has worked in the Medical Unit of Cal-OSHA for 28 years, and at the 25 year award ceremony was publicly commended by Mr. Welsh. ;Dr. Rose is an Occupational/Environmental Medicine specialist (a specialty that combines preventive public health medicine, epidemiology, and toxicology), with an academic appointment, and has always been strongly committed to strengthening the mission of the Cal-OSHA statewide workplace injury and illness prevention enforcement program. Throughout Dr. Rose's tenure at Cal-OSHA there were no communications that indicated any dissatisfaction with his work. Dr. Rose maintained a close positive working relationship with professional coworkers (Industrial Hygienists) in closely coordinated team work during investigations. Also in the course of his work he was in frequent extended contact with employees, employers, physicians, unions, public health officials, academic centers, other state and federal agencies, the general public, and elected officials. Mr. Welsh also stated that there is a contract with the Department of Health Services, (DHS) to use a physician (Public Health Medical Officer, or PHMO), to do compliance or enforcement work at Cal-OSHA, This is a complete fabrication since there is only one PHMO physician that works for DHS-HESIS. HESIS has been cut to the bone, and has been threatened with elimination by Mr. Welsh every year for the past three years. HESIS is a very important supportive agency to Cal-OSHA and is in the process of recommending stronger worker protections for 68 very toxic chemicals that are carcinogens,reproductive, or developmental hazards. HESIS is 50% funded by Cal-OSHA, and is only contracted to do assistance, and consultation to Cal-OSHA. There is no contract with HESIS for the only physician to do enforcement activities. This has been an informal arrangement that violates the California Labor Code. The HESIS function is clearly covered in the California Labor Code, and HESIS staffing levels ned to be brought back up to previous levels in order to perform mandated important supportive functions to improve the Cal-OSHA overall mission.


In 1975, Cal/OSHA had seven physicians and three registered nurses. When the Cal OSHA program was abolished by the Deukmajian administration there were two PHMO physicians in the statewide Medical Unit. When Proposition 97 was overwhelmingly passed in 1989 with the strong support of organized labor, and public health activists it was the intent to reestablish the Cal-OSHA program at the previous high level of functioning. If the growth of the numbers of employees, and workplaces in California is taken into account, that would require there be a minimum of three PHMO physicians in the Medical Unit, statewide. In 2006, the LWDA is planning to effectively abolish Cal/OSHA¹s Medical Unit altogether. The alleged salary savings will be dwarfed by costs of "contracting out" for medical services that Cal/OSHA is required by law to conduct. Federal-OSHA, and all of the state programs have on board Occupational/Environmental Medicine Departments that give important medically scientific fact based professional credibility to the health sector of these programs. The privatization or contracting out of professional science based government civil service positions can only be understood in the context of high level partisan public officials wanting to politically control important agencies that are mandated to protect the public, (employees, and the general public). The general weakening of agencies such as Cal-OSHA is a good example of how this is methodically and unrelentingly accomplished. Going, going, gone!

The abolition of the Cal/OSHA Medical Unit means the Division will be unable to enforce the nation¹s only ergonomics standard as citations depend on a verification of the two repetitive motion injuries that trigger the standard¹s requirements. The Appeals Board law judges have generally refused to accept non-physician evaluations of these medical criteria. So the California ergonomics standard is effectively nullified by this LWDA action.

Other key programs that depend on Medical Unit participation, and which will be much more difficult, if not impossible, include:

- evaluation of employer medical surveillance programs;
- medical expert testimony in appeal hearings;
- evaluation of bloodborne pathogens exposure control programs; and
- evaluation of adverse health effects from chemical exposures.

The abolition of the Medical Unit comes at a time when Cal/OSHA is preparing for the Asian flu pandemic and is preparing new regulations for infectious airborne diseases like tuberculosis.

All supporters of an effective Cal/OSHA program need to contact LWDA Secretary Victoria Bradshaw and Governor Arnold Schwarzenegger to demand that the one physician position be reinstated and filled as soon as possible.

Please call:

- Victoria Bradshaw: 916-327-9064

- Arnold Schwarzenegger: 916-445-2841

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A more complete description of the functions of the Medical Officer in Cal-OSHA would include:

1. Provides medical expertise to link exposures to employee illness,
particularly when those exposures are not already controlled by
regulations. Often, these investigations are in new technologies, or
new uses of chemicals, for example in the biotech industry.

2. Interprets medical records and provides medical testimony at
hearings. Medical record review is necessary in all repetitive motion
injury cases. It is also necessary to establish that an employee has
sustained a "serious injury" as defined by the Labor Code in order
that accident-related penalties are applied.

3. Recommends and evaluates medical surveillance programs both for
chemical hazards and biological agents. For example, the physician
helped to establish Cal/OSHA protocols for requiring control measures
for tuberculosis, in health care settings, prisons, and other high
risk situations. The physician evaluates the results of biological
monitoring for exposure to toxic agents.

4. The Cal/OSHA physician recommends special orders in workplaces
where there is no existing standard to address hazards. These special
orders have included protecting employees against Q-fever,
tuberculosis, ergonomic hazards, and heat stress. There are many
other functions that the physician provides, including mentoring
occupational medicine residents, serving as a resource in regulatory
development, interfacing the program with the medical community, and
providing advice in individual cases and in the development of
programs and publications. It is critical to maintain this position,
since once lost, it is unlikely to be restored. Larry Rose M.D., MPH
Cal/OSHA Medical Unit (415)383-6540


Cal/OSHA Alert: Cal/OSHA Functions at Risk

The last remaining Occupational Medicine physician in the Cal/OSHA
program is being eliminated. This important position was selected for
elimination due to the reduction in the overall budget for the
Division. It is 50% funded by federal funds. This creates a crisis in
the effectiveness, and credibility of the entire Cal/OSHA compliance
and consultation programs.

The Cal/OSHA Medical Unit Physician functions in close coordination
with the compliance safety and health officers whenever there is a
medical problem caused by workplace environmental exposures. This
coordinated investigation usually consists of on-site interviewing of
affected employees reviewing doctor1s first reports, interviewing
evaluating/treating physicians, and obtaining all up to date relevant
medical records.

There are several specific substance standards, (e.g. lead, asbestos,
arsenic, etc,) that require detailed medical surveillance when
various trigger exposure levels occur. Whether or not the
requirements of these standards are met needs the review of a health
care professional.

At a certain high level of exposure to any toxic that is causing a
serious health reaction immediate, and ongoing medical surveillance
can be required. This can only be developed by interviewing all
exposed employees, reviewing all work related medical records, and
looking at past and probable future exposures to determine the
initial and ongoing periodic medical surveillance requirements.

The main investigations where participation of the Medical Unit
physician are critically important are:

1. The Ergonomic Standard (Title 8, 5110), where only the physician
in the Medical Unit can make the contacts to determine that each
injury recorded is a true repetitive motion injury primarily caused
by job task factors.

2. The Bloodborne pathogen standard (Title 8, 5193). This complex,
very detailed standard requires a thorough up to date grasp of the
rapidly changing risks for transmission of HIV and hepatitis in
hospitals, clinics, and other health care settings where health care
worker exposures occur. The adequacy of the needlestick prevention
programs, the needlestick post exposure prophylactic programs,
training, engineered sharps program, is a constantly changing
picture, and needs a health care professional1s evaluation in the
course of any bloodborne pathogen investigation.

3. Infectious disease exposures such as tuberculosis, SARS, Q Fever,
Coccidiocycosis, rabies, Legionaire1s disease, and bioterrorism
organisms such as anthrax, smallpox, need the input of the Medical
Officer responses for credible effective response to employee
concerns and complaints.

4. Indoor air quality health complaints, need Medical Officer
reviews. True building related illnesses such as asthma
exacerbations, Legionaires1s Disease, upper respiratory infections,
CNS reactions, need to be evaluated using treating physician
interviews, and medical records. Linking specific health reactions to
airborne conditions in various building areas needs special medical
input. Multiple Chemical Sensitive employees often need special
reviewing.

5. Often employees that are expose to carcinogens, reproductive
hazards, hormone disruptors, and CNS toxics, need detailed review to
direct exposed employees to selected health care specialists.

6. Clusters of cancers, adverse reproductive events, and other
medical diagnostic catagories frequently require epidemiologic
screening.

In addition to the above six categories of frequent investigation
participation the Medical Officer:

1. Supervises the medical surveillance program of Cal/OSHA compliance
officers.

2. Participates in fatality investigation

3. Evaluations of new or emerging diseases, or health issues.

4. In legal appeal, and settlement proceedings gives input in
depositions, and as an expert witness.

5. Frequent telephone responses to employee, and employer inquiries about health reactions and prevention as related to workplace
exposures.

6. Develops health Hazard Alerts.

7. Advises health care professionals regarding Cal/OSHA requirements.

8. Helps screen health complaints for district offices (particularly
infectious diseases).

9. Responds to telephone inquires about health reactions, and
prevention as related to Cal/OSHA regulations.

10. Lectures to heath care workers when requested.

11. Consultations with employers when requested.

12. Developing and coordinating the residency training program at
Cal/OSHA as a member of the Department of Medicine at UCSF.

13. Liaison with infectious disease departments, and CDC.

14. Interacting with other state agencies such as DHS, EPA, Pesticide
enforcement.

15. Developing standards.

16. When Employees are exposed to high levels of toxic materials
Cal/OSHA can require a Medical Surveillance program. The development
of this program includes interviewing exposed workers, review of past
and probable future exposures, and a medical determination that
includes items of appropriate surveillance protocols such as:
laboratory tests, X-rays. lung function tests, and biologic tests

If the Public Medical Officer position in Cal/OSHA is eliminated, no
one in CAL/OSHA will be able to effectively fill these critically
important functions.

Proposition 97 passed by the electorate in1989 required that the
state OSHA program should be reinstated at the previous level of
effectiveness, or at least as effective as Federal-OSHA The Cal/OSHA program is now responsible for protecting
the health and safety of more than 17 million workers in the State of
California. In 1989 there were two Medical Officer positions in the
Cal/OSHA program, and to reflect the increased number of employees, and workplaces there should be at least three Medical Officer positions in Cal-OSHA at present.


Cal/OSHA, Decreasing Effectiveness Due To Staffing Level Failures

Cal/OSHA: Tiger Team Enforcement or Paper Tiger?

At present the Division has 193 field officers, covering compliance,
high-hazard industries, process safety management and mining and
tunneling.

That is a ratio of one inspector for about every 91,191 workers and
6,100 workplaces. One or more of the top three leadership positions
within DOSH has been vacant for "significant periods" in the last
several years. Recently the vacant chief's post was filled by Len
Welsh, who still has to be officially nominated by the governor and
confirmed by the state Senate. That job was vacant for almost a year
after the departure of John Howard.

The Division has had no deputy chief for health since 2000.

DOSH's "benchmark" for inspector staffing remains at l98, the level
that Fed-OSHA accepted in 1994. Previously the benchmark had been 805
inspectors, based on a 1980 U.S. Court of Appeals decision in AFL-CIO
v. Marshall. The Benchmark constitutes the "fully effective"
compliance staffing level of a state program. OSHA had recommended to
the court that California allocate 334 safety and 471 health
compliance officers.

But in l993 the Department of Industrial Relations reassessed
California's staffing requirements and came up with a benchmark of
118 safety and 80 health officers.

Whether or not the 805 benchmark was ever realistic, the new benchmark
has remained static for almost 10 years while the number of
workplaces has risen 21 percent and the workforce has increased 13
percent. The ratio of inspectors to workers has declined 6 percent
since 2001 - from 1:86,212 to 1: 91,191
If the ratios of inspectors to workers in California were compared to other state programs such as Oregon, Washington State, or North Carolina, or British Columbia, or Ontario, Canada, Cal-OSHA should have five times as many inspectors. In 1975 Cal-OSHA was the strongest state OSHA program in the country. It is now one of the weakest programs, and this is a disgrace. The insufficient level of enforcement staffing has lead to an inability of the agency to meet the mandated responses as enumerated in the California Labor Code, and in the DOSH Policies and Procedures as follows: the numbers of inspections being performed by the 21 district, and field offices is on the decline, inspections are not being opened within the required 14-day period, inspections are not being closed in a timely fashion, unfairly declaring an increasing number of complaints "invalid", targeted inspections in high hazard industries, and in process safety management are short changed, required follow up inspections for serious infractions are not being done, a reduction in previous programmed inspections in agriculture, construction, garment, and restaurant industries, less verification of abatement, or correction of cited hazards, weakened defenses of legal appeals by employers. These enforcement deficiencies have been clearly documented and are worsening. If a committed effective administration were operating the thirty vacant field inspection positions would be hired and trained on an emergency basis, and five times as many inspectors plus three physicians would be presented to the legislators for funding as urgently needed to accomplish an effective Cal-OSHA.


April 2003 California has more fish and game wardens than workplace
safety and health inspectors - 227 vs. 193