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John Furman
Pacific Northwest Agricultural Safety and Health Center
Employer must provide ChE monitoring
and testing to employees who meet a
predetermined exposure threshold
- Initial clinic visit
- Baseline and periodic testing
No cost to the employee - No job, benefit, seniority loss for participation
- Testing done on employer time
- The employer must provide training prior to the initial medical evaluation
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Human health hazards of cholinesterase-inhibiting pesticides
- Purpose and requirements for medical monitoring
- The medical provider will discuss the risks and benefits of cholinesterase testing
- Employer must provide the opportunity for testing
- The employee may decline participation in the testing program after discussion with the medical provider
- The rule requires covered employees to undergo an initial clinic visit
- The option to participate applies to the testing program only
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WISHA generally does not require employees to consent to invasive medical procedures
- Shifts burden of providing clinical information from the employer
- Protects the employer from allegations of coercion
- Vulnerability to coercion= limited Vulnerability
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By employee status
- By minority status, language,
literacy
Thus, special considerations apply
- A process
- Process is informed by pt’s legal rights and clinicians ethical duties
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Information exchange
- Comprehension
- Voluntary choice
- Culturally competent
- Nature and character of the treatment
- Anticipated results
- Alternative treatments
- Risks and benefits
- Beliefs - law is on their side, employer should care for employees
- Attitude - worry about getting sick from pesticides, fear blood and needles, mistrust unexplained changes, afraid to take time off to get tested
- Knowledge - very little known about blood tests, ChE test, but know that pesticides are toxic, safety gear is important, toxic, safety gear is important, employers sometimes scrimp on safety
- Language - English is a barrier to care, many handlers can’t read, recorded information and consent is better is better
- Tradition - important role of wives and social institutions for decision making and dissemination of information
Information Novella- “Jorge”
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Culturally-appropriate format
- Incorporates culturally
appropriate beliefs, attitudes,
knowledge, language
- Will be available on audiotape
What Does The Rule Say?
- Requires “Declination Statement” only after receiving training about pesticides and discussing risks pesticides and discussing risks and benefits with MD or LHCP (WAC 296-307-14820)
- The employer is required to obtain the written declination form from the medical provider
- Employee may change mind at any time
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The rule allows for a "working
baseline"
- Employee receives initial training
- Employee sent to clinic
- Pt. signs consent or declination
- Medical provider/Witness cosigns the form
- Cc: chart and patient. Declination sent to employer
- The following resources are The following resources are available through L&I
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Sample "Consent" form
- Sample "Declination" form
- Sample Training outline
- "Jorge's New Job" photo-novella
and VHS video
John Furman, PhD, MSN, COHN-S J
Dept. Labor & Industries
360-902-5666 Furk235@lni.wa.gov
Disclaimer
and Reproduction Information: Information in NASD does not
represent NIOSH policy. Information included in NASD appears
by permission of the author and/or copyright holder. More
NASD Review: 06/2006
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