Employee Medical Monitoring Program

It is the policy of the CSU that medical examinations mandated by federal and state laws and regulations be enforced by each campus. Failure or refusal of an employee to undergo required medical testing, as determined by campus management, shall constitute a failure or refusal to perform the normal and reasonable duties of the position. In such event, the campus has the authority to commence appropriate disciplinary action up to and including termination of employment.

• Evaluate the health status of potential employees, and determine whether they can perform the job in a safe and effective manner.
• Detect exposure-related adverse health effects at an early and hopefully reversible stage so that occupational diseases can be prevented, and proper medical care can be rendered, if necessary.
• Periodically assess employee suitability for ongoing or new assignments that involve potential contact with hazardous agents.
• Correlate past occupational or environmental exposures with future workplace activities and exposures, to arrive at an opinion on the risk that the job might represent to the health status of the individual.
• Provide a medical monitoring program that complies with all the pertinent Federal, State, and local regulations.
• Identify unrecognized effects of exposure by continually evaluating group employee health data to detect possible adverse health trends.
  
  

Access

Employees, their designated representatives, and authorized representatives of Cal/OSHA have full right of access to relevant exposure and medical records. Designated representatives must be given the employees written authorization to exercise the right of access. The legal representative of a deceased or legally incapacitated employee may exercise full right of access to all of an employee’s medical record.

All requests for employee medical or exposure records shall be in writing to Environmental, Health & Safety. EH&S will either have a secure Dropbox with records, or they will be with the medical provider where the employee was seen and a copy can be requested from that provider. A copy or the requested records shall be provided to the employee or designated representative at no cost and no later than fifteen (15) days after the request is made. In the case of an original x-ray, access shall be restricted to on-site examination. Whenever a record has previously been provided without cost to the employee or designated representative, the university may charge for the record search and the cost of additional copies.

In the rare case that a request for records is denied, the employee may appeal the denial to the Division of Occupational Safety and Health (DOSH), State of California. The Chief of DOSH will make a decision on the appeal and may issue an order to release the information to the employee or their designated representative. Designated representatives must be given the employee’s written authorization to exercise rights of access. A written authorization shall contain the following:

1. The name and signature of the employee authorizing the release of the medical information.
2. The date of the written authorization.
3. The name of the individual or organization authorized to release the medical information.
4. The name of the individual or organization authorized to receive the medical information.
5. A general description of the medical information that is authorized to be released.
6. A general description of the purpose for release of the medical information, and a date or condition upon which the written authorization will expire. The employee or representative will be provided a copy of the requested medical records at no charge to the employee.

Retention, Recordkeeping and Confidentiality

An important part of the Employee Medical Monitoring Program (EMMP) is the confidentiality of the medical and exposure records generated by the program. This program has been carefully designed to ensure that the medical information for individual employees be made available only to medical professionals (including medical records services personnel) and the employee. Specifically, individual medical information is not available to CSU Dominguez Hills management personnel, and in the absence of a subpoena, will not be made available to any person other than the employee or their designated representative of State or Federal regulatory agencies, e.g. Cal/OSHA.

The only information kept on file at the University is a cover-letter describing the employee’s medical qualification to perform regular work, a description of work restrictions (if any) and the names of tests completed by the occupational medicine provider.

To ensure that the employee has a complete understanding of these confidentiality procedures and the limited uses that will be made of the employee’s medical data, each CSU Dominguez Hills employee enrolled in the EMMP is given an Authorization for Use or Disclosure of Health Information form by the occupational medicine provider. Employees are asked to sign the form before beginning an exam. The signed authorization form allows the occupational medicine provider to send the records to the campus. In cases where the medical provider will maintain those records, then this form will not be required as the records are kept with the health professional, which could include the CSUDH Student Health Center.

Often, an employee may have undergone a previous medical examination. This information may be of value to the physician performing the exam. If the employee authorizes, copies of these old records may be obtained. The form, Authorization for Use or Disclosure of Health Information, is to be used for this purpose. Medical and exposure records are maintained for 30 years after the termination of employment at California State University, Dominguez Hills.

Definition of Medical and Exposure Records

a. Medical records include the following

1. Medical and employment questionnaires and histories.
2. The results of medical examinations and laboratory tests.
3. Medical opinions and diagnosis, progress rates and recommendations.
4. First aid records.
5. Description of treatment and prescriptions.
6. Employee medical complaints.

b. Medical records do not include medical information in the form of:

1. Physical specimens (e.g. blood or urine samples) which are routinely discarded as part of normal medical practice.
2. Records created solely in preparation for litigation which are protected from discovery under applicable rules of procedure on evidence.
3. Records concerning voluntary employee assistance programs.

c. Exposure records

1. A record containing measurements or monitoring results of the amount of a toxic substance or harmful physical agent to which the employee is or has been exposed.
2. In the absence of directly relevant records, records of other employees with past or present job duties or working conditions related to or similar to those of the employee, may be used to indicate the amount and nature of the toxic substances or harmful physical agents to which the employee is or has been subjected.
3. Exposure records to the extent necessary to reasonably indicate the amount and nature of the toxic substance or harmful physical agent at workplaces or working conditions to which the employee is being assigned or transferred.

Comprehensive Medical Examination

1. Identification Provided: Name, birth date, gender, job title, department, etc.
2. Personal medical history:

1. Medications
2. Allergies
3. Illness, injuries, hospitalizations, surgeries
4. Smoking, alcohol, drug histories
5. Medical conditions-specifically lung disease, heart disease, liver disease, skin conditions neurological diseases

1. Family medical history: specifically cancers and lung heart liver disease, skin conditions,
2. General Appearance and Physically Development and Posture: Height and weight are recorded.
3. Head-Eyes: Titmus vision testing including near, far, color vision and depth, lateral phoria, esophoric, exophoric and vertical phoria (right and left hemisphere) and peripheral vision. Also noting ptosis, discharge, visual fields, ocular muscle imbalance, presence of corneal scarring, exophthalmos or srabismus uncorrected by corrective lenses. If the applicant wears contact lenses, it will be noted whether they have good tolerance and has adapted to their use. All vision testing is done without corrective lenses and then with the corrective lenses. This is done in order to determine a baseline vision as well as effectiveness of corrective lenses. Note that certain positions do not allow the use of contact lenses.
4. Ears: Audiometric tests shall be pure tone, air conduction, hearing threshold examinations with test frequencies including as a minimum, 500, 1000, 2000, 3000, 4000 and 6000 Hz. Tests at each frequency shall be taken separately for each ear. Audiometric screening should meet specifications of, and be maintained and used in accordance with ANSI, S 3.6-1969. Audiometry testing room should meet the requirements for maximum allowable octave-band sound pressure levels for audiometric test rooms. In addition, audiometric calibration should be checked acoustically on an annual basis according to Title 8 California Code of Regulations, Section  5097 Appendix D. Ear examination also includes noting any evidence of mastoid or middle ear disease, discharge symptoms of aural vertigo or Meniere’s Syndrome.
5. Throat: Examination includes detection of any deformities of the throat, larynx, masses or nodes which may interfere with normal breathing and eating.
6. Heart: Auscultation by stethoscope for heart sounds, presence of murmurs, clicks, rubs, additional heart sounds and dysrhythmias. PMI will be ascertained and full cardiac history is obtained for symptoms such as dyspnea, palpitations, syncope. Blood pressure determinations are also made.
7. Pulmonary: Examination of lungs and thoracic area. Breath sounds are examined specifically noting any signs of chronic obstructive pulmonary disease, congestive heart failure and history of lung disease like asthma or bronchitis.
8. Gastrointestinal System: Complete history, and current signs and symptoms will be noted. Noting will be made specifically for presence of hernia, scars, weakness or injuries, location, size and character of any abdominal masses. Bowl sounds will also be noted. A rectal examination with stool guaiac will be obtained on all male employees over 50 years of age.
9. Genitourinary: Examination for presence of infection or other abnormal findings including urinalysis (noting uncontrolled diabetes, presence of albumin).
10. Neurological: Examination includes pupil reflexes for light and accommodation, sensory, vibratory and positional movements.
11. Extremities: Close examination of all extremities for color, warmth, presence of peripheral pulses and skin tugor. Any deformities, paralysis or varicose veins and leg muscle weakness will be documented.
12. Spine: History of pain, injuries, and physical examination for deformities will be performed.

Additional Tests as Required

1. Resting 12-lead Electrocardiogram: Electrocardiograms will be read by a Board Certified Cardiologist. 
2. Treadmill EKG: or MASTER TEST
3. Pulmonary Function Testing: To include (at the discretion of the examining physician):

1. FVC- Forced Vital Capacity
2. FEV 1.0-Forced Expired Volume in one second
3. FEV 3.0-Forced Expired Volume in three seconds
4. FEF 25-75 - Forced Expiratory flow
5. RV - Residual Volume

Results of pulmonary function testing are calibrated in prediction equations. Degree of respiratory impairment is assessed. Some obstructive diseases that may be associated with abnormal findings include: chronic bronchitis, asthma and emphysema. Restrictive diseases like pleural thickening, pulmonary fibrosis and congestive heart failure are associated with other abnormalities found in pulmonary function testing. All pulmonary function testing equipment must be approved by the American Thoracic Society and the operators must be certified by NIOSH (National Institute for Occupational Safety and Health).

1. Complete Blood Count (RBC, Hgb, HCT, WBC, differential)
2. Blood Chemistry Panel, Requiring any/all of the following tests:

   Glucose	Sodium	Potassium
   Chloride	Creatinine	BUN
   Phosphate	Uric acid	Cholesterol
   Total protein	Calcium	Globulin
   Triglycerides	Albumin	Total Bilirubin
   Alkaline Phosphatase	G-Glutamyl Transpep	Transaminase (AST ALT)
   LDH	Sickle Cell Index	Lead
   Mercury	Cadmium	Cobalt

All laboratory testing is performed by a CLIA approved and licensed clinical laboratory.

1. Chest X-Rays: Posterior / anterior view x-rays. Radiologist interpretation should be done by a Board Certified Radiologist. For employees with potential asbestos exposure, Certified “B” readers will interpret x-rays.
2. Urinalysis (with Microscopy) to test for:

1. Biological Monitoring for Lead:

Blood lead level

Hemoglobin and hematocrit, red cell indices and peripheral smear morphology. Zinc protoporphyrin (ZPP)
Blood Urea nitrogen and creatinine

1. Red blood cell and Plasma Cholinesterase Tests
2. Stool Specimen

Submitted for culture and examination for OVA and parasites

ANNEX - SPECIFIC STANDARDS AND PROTOCOLS