Public Health Law Map - Beta 5 - Medical and Public Health Law Site

ethical obligations concerning the maintenance and confidentiality of employee
medical information, the duty to disclose information to a patient/employee or any
other aspect of the medical-care relationship, or affect existing legal obligations
concerning the protection of trade secret information.” The rules do not pose any
ethical problems beyond those already inherent in occupational medicine practice. In
the case of providing access to trade secret information, they help resolve an existing
ethical dilemma.
2. Defining OSHA-Regulated Occupational Medicine
The OSHA regulations indirectly define occupational medical practice by
establishing what constitutes OSHA occupational medical information. By inference,
physicians generating such regulated medical information are practicing occupational
medicine as regulated by OSHA. The regulations apply to any employer “who
makes, maintains, contracts for, or has access to employee … medical records …
pertaining to employees exposed to toxic substances or harmful physical agents.”
The rules include all medical records maintained on a covered employee—not just
those mandated by “specific occupational safety and health standards.” The rules
specifically include records maintained by physicians who are not employees of the
covered employer but provide medical services on a contractual or fee-for-service
basis. There are additional regulations that require monitoring of exposure to specific
toxic substances. These regulations prevent employers from avoiding the rules on
employee medical records by ignoring employee health entirely.
It is the definitions of exposure and toxic agents that account for the broad reach of
these rules:
“Exposure” or “exposed” means that an employee is subjected to a toxic
substance or harmful physical agent in the course of employment through any
route of entry (inhalation, ingestion, skin contact or absorption, etc.), and
includes past exposure and potential (e.g., accidental or possible) exposure.
“Toxic substance or harmful physical agent” means any chemical substance,
biological agent (bacteria, virus, fungus, etc.), or physical stress (noise, heat,
cold, vibration, repetitive motion, ionizing and non- ionizing radiation, hypo-
or hyperbaric pressure, etc.) which (i) Is listed in the latest printed edition of
the National Institute for Occupational Safety and Health (NIOSH) Registry
of Toxic Effects of Chemical Substances (RTECS); (ii) Has yielded positive
evidence of an acute or chronic health hazard in testing conducted by, or
known to, the employer; or (iii) Is the subject of a material safety data sheet
kept by or known to the employer indicating that the material may pose a
hazard to human health.
Given that the current edition of the RTECS contains over 45,000 chemicals, it is
hard to imagine an industrial employee who is not covered by these regulations. The
addition of biological agents expands coverage to most health care workers. The
inclusion of repetitive motion and nonionizing radiation adds every office worker
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