Welcome Back to U.S. DOE Occupational Medicine
- and to Secretary of Energy, Dr. Stephen Chu
Since our first edition, several important changes have occurred
within the DOE Complex, none as important as the confirmation
of the new Secretary of Energy, Dr. Stephen Chu - a DOE
scientist, laboratory director, and Nobel Prize winner. As the past
Director of DOE’s Lawrence Berkeley National Laboratory,
Dr. Chu has insights into the health and safety programs at Office
of Science Laboratories and we look forward to his leadership on
a wide range of issues. In this issue, we are considering a
variety of programs which further DOE’s strategic objective of
bringing occupational health services to workers wherever and
whatever the nature of their work.
From the Office of Corporate Safety Analysis, DOE’s "Feedback
and Improvement Engine:" HEALTH & SAFETY IS WORKING!
Bill Roege, Director of the Office of Corporate Safety, reports that overall measures of
DOE worker health and safety reflect over 50% decline in OSHA-reportable injuries and
illnesses since the year 2000 (see bar chart below). Although data must always be
interpreted with care, this is certainly in large part the result of commitment from both
workers and management to Integrated Safety Management (ISM) under the leadership
of Mr. Michael Kilpatrick, DOE’s Deputy Chief for Health Safety, and Security (HSS), the
recent recipient of the Secretary of Energy’s “Excellence Honor Award."
The impact of 10 CFR 851 Worker Safety and Health Programs rule, promulgated in 2006
through the newlycreated DOE Office of Health, Safety, and Security, is another
likely contributor to the further declines in injuries and illnesses.
The Office of Corporate Safety (HS-30) under the direction of Bill Roege, a
former Air Force pilot and safety manager, is a multi-pronged force which,
among other activities, uses the Computerized Accident/Incident Reporting
System (CAIRS) to collect, track, and analyze "metrics" which, when
carefully interpreted, can reflect both progress and areas for improvement in
DOE’s battle to continuously improve worker health and safety. In addition,
the team generates safety alerts and bulletins regarding recognized or
emerging safety concerns, annual reports regarding the status of DOE’s
efforts and progress in a variety of areas of safety, and briefs DOE’s senior
leadership as needed. DOE thereby strives to be a "learning organization."
Contact: Mr. Bill Roege (William.roege@hq.doe.gov or (301) 903-0502).
Argonne National Laboratory’s Dr. Jamie Stalker – the New Chair
of EFCOG’s Occupational Medicine Subcommittee
Congratulations to ANL’s Dr. Jamie Stalker on her appointments in October 2008 as Chair
of the EFCOG Occupational Medicine Subcommittee. In this important role, she leads
occupational physicians throughout DOE in their ongoing efforts to identify emerging
concerns to worker health and safety, to facilitate the development of best medical
practices, and to communicate the changing needs of site health and safety programs to
DOE’s Office of Health and Safety. Dr. Stalker is board-certified in Internal Medicine,
graduated from Chicago’s own Rush Medical School, and completed undergraduate
studies and research at Indiana University’s acclaimed Biology Department in Bloomington,
Indiana.
Dr. Stalker has been employed as an Occupational Health Physician at Argonne National Laboratory since
January 2001 and was appointed Medical Director at Argonne in 2004. In 2008 she was chosen by Argonne to
participate in the Strategic Laboratory Leadership Program at the University of Chicago Graduate Business
School. She is active in education of Occupational Medicine residents in cooperation with the University of Illinois
in Chicago. She is also a member of the Midwest Business Group on Health’s Medical Director Council, the
Chicago Medical Directors Group, ACOEM and American Biological Safety Association. She has a strong interest
in integration of safety and health electronic databases and is applying this in her cooperation with ORAU and
Occupational Health Link in a pilot web based electronic database system for Medical Surveillance at Argonne.
Contact: Dr. Jamie Stalker (jstalker@anl.gov or 630-252-2810).
The Revitalization of Employee Assistance: Welcome to Maritza Skelton,
DOE’s New Contractor EAP Program Manager
The Office of Health and Safety welcomes its new Contractor EAP Program Manager,
Ms. Maritza Skelton, a Licensed Independent Clinical Social Worker and Board-
Certified Employee Assistance Professional with critical experience overseeing the
Government Accountability Office’s (GAO) EAP network. She will be coordinating HS-
10 support for contractor EAP and substance services which are vital to DOE and
DOE workers’ health, safety, AND security. Ms. Skelton will be benchmarking DOE
contractor EAP services to ensure that the EAP services meet the Federal and
industry standards, while providing consultation and guidance to EAP contractors from
the Federal and HQ levels.
Ensuring the effectiveness of DOE’s EAP services continues to be a collaborative effort between the Office of
Management which has promulgated and revises DOE O 350.1 Contractor Human Resources Management
Programs (Change 05/08/98) which establishes the basis for DOE contractor EAPs and substance abuse
programs within DOE; and the Office of Health and Safety which has promulgated 10 CFR 851 Worker Safety
and Health Rule which provides that site occupational medicine programs review and approve established
EAPs.
In addition, 10 CFR 707 Workplace Substance Abuse Programs calls for the services of EAPs in the
furtherance of security programs. Ms. Skelton will therefore be working closely with all DOE EAPs to promote
their effective service and to support our committed DOE employees who are challenged to balance their
professional and personal lives. Contact: Maritza Skelton
(maritza.skelton@hq.doe.gov or (301) 903-7776).
Case Files from DOE’s
Radiation Emergency Assistance Center/Training Site (REAC/TS)
The U.S. DOE's Radiation Emergency Assistance Center/Training
Site (REAC/TS) in Oak Ridge, TN is tasked with providing technical
support to occupational health providers and to workers within the
DOE complex and responds 24/7 to calls for assistance from around
the world with expert advice regarding dose estimates and medical
management of radiological exposures or internal contamination
with radioactive materials. DOE’s Office of Health and Safety is
pleased to be a long-standing sponsor and supporter of REAC/TS
and will be presenting a series of cases within this newsletter as
prepared and submitted by Dr. Doran Christensen, REAC/TS
Associate Director. Thus, occupational health providers may
sharpen their case management skills, while our valued workers and
managers will gain awareness regarding the tremendous support
they will receive should the unthinkable occur.
A recent call came to REAC/TS from Brazil where a teletherapy
device engineer's was accidentally exposed to a 1,490 Ci cobalt-60
teletherapy source. The worker was changing out the smaller source
for one of 6,000 Ci when the smaller source failed to release from
the change-out tool as he attempted to put it into a protective cask.
He unwittingly put his hand on the "business-end" of the change-out
tool in front of the shielding on the handle.
As soon as he realized what he had done, he quickly moved his hand to behind the shielding. Initial estimates of
exposure time to the worker's fingers were on the order of seconds. Preliminary calculations of the potential dose done by
the employer's physicist were on the order of less than 600 rad (6 Gy) so there was not much concern for serious
radiation injury immediately after the incident. As is often the case, the worker had no immediate symptoms or signs of
injury. But, on day 15 following the exposure incident, REAC/TS received the call that the worker began experiencing
redness and swelling on the dorso-radial aspect of his left index finger. Digital sequential photos of the injury were sent
via the secured internet to REAC/TS for evaluation. On the basis of the appearance of erythema at day 15, the dose to
skin was estimated at about 600 rad, the threshold for erythema from ionizing radiation. In spite of the initial relatively
benign appearance of the injury, aggressive treatment was recommended including topical steroid ointment, oral
pentoxifyline (Trental®), scrupulous attention to wound care and strict avoidance of pressure or excessive heat/cold.
As REAC/TS received subsequent photos that showed blister formation, a
higher dose was estimated. REAC/TS monitored the case for more than two
(2) months to ensure no further complications. Of concern in these cases is
the peculiarity for radiation skin injuries to recur unexpectedly, sometimes
months after the initial incident. Contact: Doran Christensen, REAC/TS
Associate Director (doran.christensen@orise.orau.gov or (865) 576-3131).
Keys to managing radiation injuries and illnesses:
- Physicians should consult with health physicists accustomed to performing dose estimations and/or call REAC/TS
- Dose estimations need to take into account the quality of various radiations and their interactions with tissue
- Incident reconstructions are fraught with variables such as time in the area and distance from the source, which both affect dose estimates - a small deviation in time or distance can greatly affect the dose estimate.
- Dose estimations and incident reconstructions is a process not an event - they sometimes must be repeated, often many times
- Keep workers fully informed and advised of the complexities and uncertainties of dose estimations and incident reconstructions that are used to guide medical management
- Remember to use dose estimates to help guide treatment, not dictate it - treat what you are seeing.
Next Issue: Americium-241 Inhalations by Environmental Worker
Federal Occupational Health Services: A Key Partner
in Advancing DOE’s Occupational Health Services
Dr. Gene Migliaccio, the Director of Federal Occupational Health Services (FOH), is
a former U.S. Air Force health services administrator and retired Public Health
Service Officer leading DOE’s primary partner in advancing the health and safety of
federal workers. FOH is located within the U.S. Department of Health and Human
Services from whence it provides occupational health, safety, and wellness services
to more than 500,000 federal employees. FOH’s medical consultants are wellinformed
regarding applicable government and industry “best practices” - even
referenced by both DOE (DOE G 341.1-1A Guide on Federal Employee
Occupational Medical Programs) and OPM guidance regarding employment
practices and benefits. FOH thus provides not only direct service to federal workers
at DOE sites where federal workers predominate and to federal workers who
manage contractor activities at the remaining DOE sites, but also sets a standard
for DOE’s contractors in the delivery of occupational health services.
In fact, FOH has been partnered with DOE to provide services for almost 20 years and currently supports
thirteen (13) DOE sites, including DOE Headquarters in Washington, D.C., Argonne National Laboratory,
Golden Field Office, Richlands Operations Office, National Nuclear Security Administration in New Mexico,
Office of Secure Transportation, Savannah River Site, and the Power Management Administrations. DOE sites
and federal agencies in general are charged with complying with a number of agency-specific directives, as
well as government-wide regulations relating to employee health and safety. FOH provides these services
through convenient Interagency Agreements in accordance with the provisions of the Federal Acquisition
Regulations, Public Law 79-658 and the Economy Act. Flexibility is important, because changes in service
requirements can occur rapidly and interagency agreements negate the need for contract modifications.
For example, FOH’s Medical Surveillance Program involves the systematic assessment of employees
exposed or potentially exposed to occupational hazards. As potential hazards are recognized or
enter the workplace, FOH can quickly and conveniently adapt to the additional requirements
for medical surveillance. In addition, FOH offers a complete range of occupational health services
which can be customized to meet the unique needs of an organization and help assure compliance with
all applicable regulatory standards.
Lastly, FOH supports both workers and employers through its medical employability services which
facilitate requests for reasonable accommodations by workers under the protections of the Americans
with Disability Act Amendments Act (ADAAA) of 2008, an increasing priority for employers such as
DOE striving to retain a highly-valued and aging workforce. Consultations regarding stay-at-work
and return-to-work determinations and Family and Medical Leave Act requests are increasingly
important as workers live and work longer while managing a variety of health concerns with potential
impact on essential duties they undertake on DOE’s behalf. As such benefits are increasingly sought and
utilized, assurances of worker confidentiality and independent verification make FOH an increasingly
attractive partner. Contact: Kathleen Berman, FOH Consultant (KaBerman@psc.gov or
(303) 236-0076 x 259).
Americans with Disability Act Undergoes Significant Change
The Americans with Disability Act Amendments Act (ADAAA), effective January 2009, is an important piece of
legislation with implications for the DOE workforce and its occupational health providers. As workers
increasingly survive childhood injuries and illnesses through the advancements in medicine and technology,
they present to DOE and other places of employment with unique concerns and needs in terms of post-offer,
pre-placement medical assessments. Similarly, the aging workforce more often requests "reasonable
accommodations" under the protections of the ADAAA in order to continue working in potentially hazardous
environments. Occupational health providers play a critical role in this area by providing DOE and its
contractors with medical recommendations which must consider these complex matters. The ADAAA retains
the basic definition of "disability" as an impairment that substantially limits one or more major life activities, a
record of such an impairment, or being regarded as having such an impairment. However, significant changes
in each of the associated terms must be carefully considered by occupational health providers.
For additional information, consider the following resources:
- ADA Federal Government Homepage: http://www.ada.gov/
- DOE Office of Equal Employment and Diversity: http://diversity.doe.gov/
- Office of Compliance Assistance Policy, U.S. Department of Labor: http://www.dol.gov/compliance/index.htm
- Equal Employment Opportunity Commission concerning the ADAAA: http://www.eeoc.gov/ada/amendments_notice.html
- Guide to Disability Rights Law: http://www.ada.gov/publicat.htm#Anchor-14210
- DOJ Civil Rights Division enforces ADAAA: http://www.usdoj.gov/crt/
- DOJ Disability Rights: http://www.usdoj.gov/crt/drs/drshome.php
Highlighting AdvanceMed Hanford Occupational Medicine Services
Beryllium-Affected Workers Cardiopulmonary Rehabilitation - A Winning Team Effort
Dr. Victor Nwiloh and the staff of AdvanceMed Hanford have established an
evidence-based, yet innovative approach to supporting the medical needs of
beryllium-affected workers which reflects the important principles of tertiary
prevention or disease management. The AdvanceMed Cardiopulmonary
Rehabilitation Program was put into place for the specific benefit of berylliumaffected
workers and is designed to initiate the rehabilitation process,
restore/maintain functionality in the individual and, most importantly, teach the
individual how to maintain a conditioning level. Fundamentally, the twelvesession
program is modeled after cardiopulmonary rehabilitation programs for
individuals with chronic obstructive pulmonary disease (COPD). In addition to
existing baseline assessment and conditioning services, a bi-annual
assessment is performed by AdvanceMed staff, including pulmonary function
testing, blood pressure, body composition analysis, submaximal graded
exercise testing to evaluate aerobic capacity, oxygen saturation as measured
by finger pulse oximeter, and dyspnea scale grading.
With the number of participants too low for meaningful statistical analyses at
present and a limited duration of the cardiopulmonary rehabilitation program, it
is premature to draw any statistically significant conclusions about its
effectiveness, but the subjective improvements are evident. Dr. Nwiloh notes that an additional benefit they
have identified is that workers gain a sense of control over their disease process - manifest or potential - and
that Site contractors appreciate the availability of a program that enables workers to participate in rehabilitation
on-site. Participating workers, in turn, appreciate the convenience, safety, guidance and individual attention
provided to them. Contact: Ms. Kim Conley (Kimberly_d_conley@rl.gov or (509) 373-6160).
New Office of Health and Safety Webpage for Beryllium-Affected Workers
DOE workers and vendors who have developed sensitivity to beryllium or who have chronic beryllium disease
(CBD) may now go to a single source of information to understand their medical condition and to learn whether
they are eligible and how to apply for health care and other financial benefits under the Energy Employees
Occupational Illness Compensation Program (EEOICP). In addition to information regarding the EEOICP,
workers will find links to the DOE’s Former Workers Program under which former workers are eligible for free
periodic health screenings that are focused on identifying health outcomes potentially associated with
exposures to workplace hazards during employment at DOE. Other resources pertaining to beryllium and CBD
are available through the Centers for Disease Control (CDC), the National Institute for Occupational Safety and
Health (NIOSH), OSHA, and EPA. Contact: Claudia Beach (claudia.beach@hq.doe.gov or (301) 903-9826).
Webpage: http://www.hss.energy.gov/healthsafety/berylliumaffectedworkers/.
2009 Chemical Safety and Lifecycle Management Workshop – Lean and Green
Coming this Spring to the Forrestal Auditorium near you is a free
DOE workshop, "Chemical Safety and Lifecycle Management –
Lean and Green" spotlighting lean and green chemical
management and nanotechnology. The EFCOG Environment,
Safety, and Health (ESH) Working Group’s annual Spring Meeting
sessions are public and will also cover industrial hygiene,
occupational safety, chemical safety, and radiation safety. Safety
and health professionals who participate earn valuable certification
maintenance points. Additional information regarding past years’
agenda, presentations, and registration. Contact: Mr. Dan
Marsick (dan.marsick@hq.doe.gov (301) 903-3954) or go to:
http://www.hss.energy.gov/HealthSafety/WSHP/chem_safety/.
Submitting Blind Samples Under
10 CFR 707 - Workplace Substance Abuse Program at DOE Sites
Recently a question came to HQ regarding the 10 CFR 707 drug testing programs. The question was: "what
are DOE’s requirements for submitting blind drug testing samples?" The response was as follows:
"All sites must ensure that the clinics Federal comply with the HHS/SAMHSA Mandatory Guidelines for Workplace Drug
Testing Programs [Federal Register: April 13, 2004 (Volume 69, Number 71)] [Notices] [Page 19644-19673] which can
be found under section (k) Agency Blind Sample Program of the HHS SAMHSA Mandatory Guidelines.
Each clinic should, during the initial 90-day period of any new drug testing program,
submit blind performance test samples to each laboratory it contracts with in the
amount of at least 20 percent of the total number of specimens submitted (up to a
maximum of 200 blind samples) and thereafter a minimum of 3 percent blind samples
(up to a maximum of 100 blind samples) submitted per quarter."
Contact: Mr. Joe Hopkins (joe.hopkins@hq.doe.gov or (301) 903-5619).
For additional information regarding the 10 CFR 707 Rule, and the HHS/SAMHSA Mandatory
Guidelines for Federal Workplace Drug Testing Programs please see the following:
- http://www.hss.energy.gov/healthsafety/WSHP/rule851/rule707.html
.
- http://www.workplace.samhsa.gov/FedPgms/Pages/HHS_Mand_Guid_Effective_Nov_04.aspx
All the Right Moves: Implementation of 10 CFR 851’s
Occupational Medicine Provisions at Nevada Test Site
Dr. Jeff Moon, the Medical Director for the Nevada Test Site (NTS),
and his staff have been leaders in the charge to implement the
requirements of DOE’s relatively new 10 CFR 851’s with respect to
Occupational Medicine. Supporting approximately 5,000 workers
who are operating under approximately 12 contractors and are
distributed over nearly 1,400 square miles of rugged terrain would
be a challenge for any occupational health program, but the NTS
team has tackled this challenge systematically.
Rolling plans were based upon a needs assessment which
considered the potential for expanded job hazard analyses,
medical surveillance requirements, clinical services, and the
requisite collection of morbidity and mortality data for contractors
and subcontractors. Site-specific issues to overcome included the
timely performance of randomized drug screens for workers
subject to the Human Reliability Program’s (HRP) stringent
requirements. In considering the strategy for implementing 10
CFR 851, Dr. Moon collaborated with the Environment, Safety,
Health, and Quality organization, Procurement, and General
Counsel.
Dr. Moon’s team now operates through two medical clinics to provide the required occupational injury
and illness care; return-to-work evaluations; medical surveillance and certification examinations;
immunizations; wellness programs; ergonomics programs; and Employee Assistance Programs.
Continued success, of course, is dependent upon strong communication, the maintenance of medical
program flexibility to address craft assignments, the recognition of changes within the workforce, and
incorporation of subcontractors as activities at NTS advance. The result is a world-class occupational
health program. Contact: Dr. Jeff Moon (moonjc@nv.doe.gov or (702) 295-6566).
The Art of Medicine: The Code of Hammurabi
Under the Code of Hammurabi which is accorded to the Ruler of Babylon, Hamurrabi (1792-1750), the
physician’s fees to be set and patients and physicians were to appeal their grievances to the King’s court.
These principles and practices were revealed by clay tablets from ancient Mesopotamia and depicted by
Robert Thom in his 45 historical painting and given by Pfizer, Inc. to the University of Michigan which has in
turn made them available to the public.
For more information, please visit the University of Michigan’s online News Service at:
http://www.ur.umich.edu.
Dr. Patricia Worthington
Director, Office of Health and Safety
U.S. Department of Energy
1000 Independence Ave., SW
Washington, DC 20585-1290
E-mail: pat.worthington@hq.doe.gov
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Dr. Michael Ardaiz
CMO, Office of Health and Safety
U.S. Department of Energy
1000 Independence Ave., SW
Washington, DC 20585-1290
E-mail: michael.ardaiz@hq.doe.gov
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This newsletter can be found on the HS webpage:
http://www.hss.energy.gov/HealthSafety/
You may also provide feedback through links on the Newsletter website.
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