• Initial clinic visit
  • Consent to participate
• Baseline and periodic testing

• No job, benefit, seniority loss for participation
• Testing done on employer time

• The employer must provide training prior to the initial medical evaluation
  • 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
  • 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
  • By employee status
  • By minority status, language, literacy

• A process
  
• Process is informed by pt’s legal rights and clinicians ethical duties
  • Information exchange
  • Comprehension
  • Voluntary choice

Informed Consent: Elements

• 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

• Culturally-appropriate format
• Incorporates culturally appropriate beliefs, attitudes, knowledge, language
• Will be available on audiotape

• 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
  • 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
  • Sample "Consent" form
  • Sample "Declination" form
  • Sample Training outline
  • "Jorge's New Job" photo-novella and VHS video

NASD Review: 06/2006