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

Employees may also have a financial stake in not getting hurt. There are often
incentives for groups of workers that do not have any serious injuries during a
specific time period.
This does not mean that physicians should collude with employees or the company to
conceal the severity of an injury. The first duty of the physician is to provide all
necessary and appropriate care to the injured worker. However, the physician should
be cautious about providing care beyond what is necessary, particularly if it is only
done to appease an angry patient.
The OSHA act requires that all work-related deaths and illnesses be recorded on the
OSHA 200 log, but it limits the recording of injuries to specific types of cases. The
act states that all injuries must be recorded unless they are “minor injuries requiring
only first aid treatment, and which do not involve medical treatment, loss of
consciousness, restriction of work or motion, or transfer to another job.” In other
words, an injury must involve at least one of these four conditions to be recordable.
Two of the four triggers are beyond the control of the medical care provider. If the
worker lost consciousness from the injury it is recordable, even if no medical
treatment is required. Also, if the employer chooses to move the worker to another
job because of the injury or the treatment, that is their decision. It is the need for
medical treatment and the restriction of work or motion that the treating nurse or
physician can control.
The simplest condition for the physician to evaluate is the need for restriction of
work or motion, but it is also the most contentious. Years of careful research by the
National Institutes of Occupational Safety and Health have shown clearly that rest
and/or splinting is not appropriate treatment for mild to moderate sprains, strains, or
tendinitis. The appropriate treatment is antiinflammatory drugs and exercise.
Unfortunately, the average worker thinks that the best thing for a sore back is a few
days sitting in front of the television. Physicians should limit the use of rest,
restrictions, or splinting to injuries that have clear signs (not just symptoms) of
moderate to severe injury. This is good medicine not just good politics.
All restrictions should be very specific about the limits on activity and the time these
limits will be in effect. A physician doing occupational medicine should never say,
“Mr. Smith is on light duty.” The restrictions should say such limits as “no lifting
over 20 pounds,” or “no typing,” or “no use of the left arm.”
The last trigger for recordability is that the injury requires medical treatment, not just
first aid. This does not mean that seeing a doctor triggers recordability. It is the
nature of the treatment, not who gives it, that makes an injury recordable. Because
the distinction between first aid and medical treatment is vague, OSHA has
established some specific guidelines.
The list is long, but there are some general rules that make sense. Second and third
degree burns, fractures, and wounds that become infected or require surgical
treatment such as sutures or debridement are severe enough that they should be
recorded. In addition, sprains and strains that require physical therapy or repeated
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