March 5, 1999

Mr. Mike Ferguson
Director-Special Projects
Bayshore Medical Center
3350 Fairview Street
Pasadena, TX 77504-1973

Dear Mr. Ferguson:

This is in response to your letter dated August 6, 1998, please accept our apology for the long delay in responding to you. In your letter, you requested information on the Occupational Safety and Health Administration's (OSHA's) revised Respiratory Protection standard, 29 CFR 1910.134. Your specific concern had to do with the requirement that a medical evaluation be completed prior to the commencement of employee fit testing.

Through previous phone conversations, it was learned that your company, the Medical Screening Group, provides a mobile unit which travels to various remote locations, mainly water treatment plants, in various states. The crew consists of "NIOSH approved" technicians who perform pulmonary function tests and blood pressure testing on employees who are required to wear respirators. According to you, a medical director, who resides in Texas, has established pre-determined parameters which indicate that an employee would be medically fit to wear a respirator if the employee's blood pressure is within a certain range, and the employee's pulmonary function test was within certain minimum levels. You believe that performing these two medical tests meet or exceed the medical evaluation provisions of the OSHA Respiratory Protection standard.

Your company protocols dictate that once an employee has been so "medically" tested, and the employee meets the pre-determined parameters, you proceed with the fit test. The medical evaluation questionnaire is completed by the employee at the time of the visit. The completed questionnaires are mailed back to the medical director in Texas, and evaluated after both the "medical" tests and the fit tests have been completed.

The medical evaluation section of OSHA's Respiratory Protection standard, 1910.134(e), states that the employer will determine each employee's fitness to wear a respirator by way of either the administration of a medical questionnaire (Appendix C of the standard), or a physical examination that elicits the same information as the questionnaire, or both. The employer is required to make arrangements with a Physician or other Licensed Health Care Professional (PLHCP) to make the evaluation, and provide a written opinion to the employer concerning the employee's ability to use a respirator.

Medical screening consisting solely of taking a blood pressure measurement and performing some pulmonary function tests does not meet the standard. The questionnaire, when it is used, must be read and evaluated prior to the fit test. The employer must provide a PLCHP who is licensed in the state in which they are practicing. It appears that the mobile crew services clients outside the state of Texas, and unless the medical director is licensed in all the states you serve, this could be a violation. Pulmonary technicians are not considered to be qualified as a PLCHP. In accordance with the standard, a medical evaluation must first be conducted by a qualified PLCHP. The PLCHP is to provide a written opinion to the employer stating whether or not the employee is fit to wear a respirator. It is only after the employee is found to be medically fit by the PLCHP that the fit test can be performed.

We hope this answers your questions. If you have further questions please feel free to call OSHA's Office of Health Compliance Assistance at (202) 693-2190, or the OSHA Regional Office in Dallas, Texas, at (214) 767-4731.

Sincerely,

Richard E. Fairfax
Director
Directorate of Compliance Programs