NACOSH Meeting                ) PRIVATE  

                              )

Pages:  1 through 256

Place:  Washington, D.C.

Date:   September 14, 2010  

IN THE UNITED STATES DEPARTMENT OF LABOR

OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION

NACOSH Meeting                )

                              )

			Tuesday,

			September 14, 2010

ATTENDEES:

		MICHAEL SILVERSTEIN, MD, MPH

		LINDA RAE MURRAY, MD, MPH

		ROY BUCHAN, DR.P.H., MPH

		DENISE POUGET

		JIM SWARTZ

		JOSEPH VAN HOUTEN, Ph.D.

		TIMOTHY J. KEY, MD, MPH

		SUSAN RANDOLPH, MSN, RN, COHN-S

		WILLIAM BORWEGEN, MPH

		MARGARET SEMINARIO, M.S.

		EMORY KNOWLES III, CSP, CIH

		PETER DOOLEY, M.S., CSP, CIH

		DEBORAH PAGE CRAWFORD

		VENETA CHATMON

		SARAH J. SHORTALL

		PAUL J. MIDDENDORF, Ph.D., CIH

		KEITH GODDARD

		DEBORAH BERKOWITZ

		ROBERT SADLER

		DR. JOHN HOWARD

		TINA JONES

		AMANDA EDENS

		MICHAEL SEYMOUR

		DR. DAVID MICHAELS

		FRANK HEARL

	P R O C E E D I N G S

(8:39 a.m.)

		CHAIRMAN SILVERSTEIN:  We do have a quorum here today, although three
members who are currently absent.  My understanding is that Tim Key and
Jim Swartz are not going to be here.  We expect Linda Rae Murray and
she's just not here yet.

		But rather than delay any further, I'd like to get started.  So I want
to bring the meeting of the National Advisory Committee on Occupational
Safety and Health to order.  And you'll see on your agenda that the
first item we have is a discussion about ethics rules.  But prior to
that, Debbie Berkowitz, who is OSHA's chief of staff, wanted to say a
couple of words.  She'll be back later for a full discussion, but Debbie
you wanted to do some introductory comments.

		MS. BERKOWITZ:  Yes.  Hi, I just wanted to welcome everybody to come
here.  I know it's a big trip to get here.  I want to tell you how much
we appreciate all the advice and assistance we get from NACOSH.  I know
this is a two-day meeting and everybody have very busy schedules.  You
will have big jobs.  So I just wanted to, on behalf of Dr. Michaels who
couldn't be here and Jordan Baran who will be here later, I just wanted
to welcome everybody here and I'll be back on the agenda in about an
hour or so.  And I know John Howard will be up first.  So I just wanted
to thank everybody.  So that's all I wanted to say.

		CHAIRMAN SILVERSTEIN:  Okay.

		MS. BERKOWITZ:  Thanks.

		CHAIRMAN SILVERSTEIN:  Thank you, Debbie.

		This is a public meeting of course, and I think because of that it
would be useful if we went around the table here and if each of the
committee members could just identify themselves and their organization.
 That will be useful.

		So Peg, would you start?

		MS. SEMINARIO:  I'm Peg Seminario.  I'm director of Safety and Health
of the AFL-CIO and I'm a labor member on the committee.

		MR. BORWEGEN:  Bill Borwegen, Health and Safety Director, Services
Employees International Union.

		MR. BUCHAN:  Roy Buchan.  I represent NIJ and I'm at Colorado State
University in the Department of Environmental Health & Radiological
Health Sciences.

		MR. POUGET:  Denise Pouget.  I'm assistant fire chief in Alexandria,
Virginia.

		MR. MIDDENDORF:  I'm Paul Middendorf with NIOSH.

		MR. SHORTALL:  I'm Sarah Shortall with the Office of the Solicitor and
I'm counsel for NACOSH.

		CHAIRMAN SILVERSTEIN:  Michael Silverstein.  I'm chair of NACOSH and
I'm with the Washington State Department of Labor and Industries.

		MS. CRAWFORD:  Good morning.  My name is Deborah Crawford and I am the
designated federal official for NACOSH.

		MR. GOODARD:  I'm Keith Goodard with OSHA.

		MR. KNOWLES:  Emory Knowles, manager, Industrial Hygiene and Safety
for Northrop Grumman Electronic System Sector.

		MR. VAN HOUTEN:  Good morning.  I'm Joe Van Houten, senior director
for Worldwide Environment, Health and Safety with Johnson & Johnson.

		MR. DOOLEY:  Peter Dooley with Labor Safe Health and Safety
Consulting.

		MS. RANDOLPH:  Susan Randolph, the Occupation Health Nursing Program
at UNC, Chapel Hill, School of Public Health, and I'm one of the health
representatives.

		CHAIRMAN SILVERSTEIN:  Before we get into the full agenda, I do want
to take a couple of minutes just to go over the materials you have.  But
even prior to that, we have Robert Sadler from the Office of the
Solicitor who is going to walk us through some of the ethics issues that
we need to know about.  Please Robert.

		MR. SADLER:  Good morning everyone.  I'd like to echo Debbie
Berkowitz's remarks.  We certainly appreciate when we get this kind of
help from such an esteemed group to help us make our decisions and work
on the matters that are before our particular agencies.

		As Mr. Silverstein said, I'm Rob Sadler.  I'm the counsel for ethics
here at the Department of Labor with the Office of the Solicitor.  And
I'm here actually to provide ethics advice for all advisory committees. 
You may be aware that we have a number here at the Department, so 20 I
believe.

		And certain types of committees are composed differently.  We have
some that are composed of special government employees.  They actually
are federal employees for purposes of their service.  But we have other
committees, like yourself, that are composed of representatives who
represent particular viewpoints or particular organizations before the
advisory committees.  So that's why I think in the summary that you've
been provided, or you should have a summary called The Summary of Ethics
Rules for Non-Federal Employees.

		The emphasis on the negative there.  You're not federal employees, so
there are a variety of less stringent ethics rules.  Although, I always
hesitate to say less stringent.  We should always be conscience of
ethics rules when we're conducting business with the government or even
in our own private sector organizations.  Many organizations these days
have very complex ethics structures within their organizations, so I'm
sure many of you are familiar somewhat with this, even before coming
here today.

		This is going to be a very short briefing.  The numbers of rules that
you're subject to are few.  I am here, obviously, to help the committee
at any time during the course of your deliberations.  If you have
questions about ethics that come up, you should certainly direct them to
the Chair or to Sarah or Deborah who can get in touch with me to get my
advice with respect to issues that come up.

		But let's talk briefly in the document you're going to see that this
is divided into three major areas, all sort of negative in their
connotation, but it says 'Misuse of Government Information, Misuse of
Government Affiliation.'  I think you can probably discern a particular
theme here.

		When you're serving on the committee in your representative capacity,
it's permissible, obviously, to use government resources, to be privy to
government information that may be provided to the committee, and to use
your position in furtherance of the mission and roles that the committee
assigns to you.

		Obviously, what this means is that you can use government resources in
conducting any of the activities, so this mean government computers or
email or access, whatever you may have, your title, your affiliation
with the Department, your title as representative member of NACOSH when
you're conducting activities in furtherance of the advisory committee.

		This could be while you're here in Washington, but certainly in the
past it's been my experience that in many cases assignments where
activities have been conducted when you're away from Washington I don't
know if that's contemplated, but that could at some point.  There could
activity subgroups that are looking at particular issues that are
working on these while they're away from Washington, D.C.

		So when you are conducting activities, whether they're here in
Washington or away, you are functioning as a member of the committee and
need to keep in mind these particular rules.

		I think the more interesting one may be the information that you may
become privy to while you're on the committee.  Generally, the
information that you're going to be getting some of it may be public. 
Some of it may not be public.  Some of it may be classified.  Some of it
may have business proprietary or personal information about individuals
that are contained in the information.

		Generally, the rule is that you're not allowed to disseminate further
information that you may become privy to while on the committee, unless
at the director of the Chair or Sarah or Deborah or you understand that
this is public information that can become available to others.

		With respect to your affiliation with the committee, it's certainly
permissible for you to say that are a representative serving on the
NACOSH Committee, to include that in your biography, to make
representations to others that you are in that capacity.  But obviously,
you need to be careful about invoking that affiliation if it is not in
furtherance of activities of the committee.  So that's essentially in a
nutshell the advice.

		My contact, I believe, is on the very front page of this document. 
That's my direct telephone number at the bottom of the very first page. 
And certain Sarah and Deborah know how to get in touch with me if there
are any questions or issues that come up.

		In the past there has been one particular issue that has arisen. 
Generally, if you're here conducting business on behalf NACOSH, for that
day I would advise, generally because of appearance issues that it's
best if there are other matters before the Department that other
representatives from your organizations should be handling those rather
than you, in particular.  I think you need to make a little bit of a
dichotomy.

		If you're here conducting or furthering activities on behalf of the
committee that's perfectly fine.  But if there are other matters pending
before the Department, then I believe if there are issues that need to
be conducted or meetings that need to be held it's probably best to have
someone else in your organization conduct that so that there's no
appearance that you're mixing the issues or some how using your position
to get general, further access to members of the agency.

		But with that, I will close.  And if there are any questions, I'd be
glad to entertain them or talk about them.

		CHAIRMAN SILVERSTEIN:  Are there questions?

		MS. SHORTALL:  Rob, I'd like to add one comment what you were talking
about in terms of the information that members may become privy to.

		MR. SADLER:  Sure.

		MS. SHORTALL:  I cannot remember the last time the committee held a
closed meeting, which if it were to be held requires that the Department
be notified and provide a justification for that.  And everything that
is presented to this committee in a meeting is added to a public record.
 So it's less likely here that we're going to have that type of
information.

		In addition, work group material is also made available and put in the
record too.

		MR. SADLER:  That clarifies that.  Good.  That should be no problem at
all.

		CHAIRMAN SILVERSTEIN:  Any other questions.

		(No response.)

		CHAIRMAN SILVERSTEIN:  All right.  Robert, thank you very much.

		MR. SADLER: Thank you very much.  Have a good day everyone.

		CHAIRMAN SILVERSTEIN:  For the record, we've been joined now by Linda
Rae Murray.

		MS. MURRAY:  Good morning, everyone.

		CHAIRMAN SILVERSTEIN:  Linda, you missed the discussion on ethics.  So
you can proceed at your own risk.

		MS. MURRAY:  That means I can be unethical?  Very good.  More
flexibility.

		(Laughter.)

		MS. SHORTALL:  Mr. Chair, I'd like to take care of a couple of
housekeeping items at this time.  I need to enter a few things into the
record.

		I'm going to preface that with a number of people have indicated that
the new system that we have were you get all the public information and
can download it from the website www.regulations.gov sometimes is not
the most user friendly item, although they're trying to improve it all
the time.

		And so to try to make the exhibits as identifiable as possible for
each meeting what we're going to do from this point forward is to put
all exhibits from a meeting in a file set and the file set will be
labeled exhibits from the September 14/15, 2010 NACOSH meeting.  And all
the items within that file set will then be a point 1, 2, 3, 4, 5.

		So what I'd like to do for that file set for this -- exhibits for the
September 14/15, 2010 NACOSH meeting indicate the agenda for the two-day
meeting is Exhibit .1.  The current roster of NACOSH members would be
Exhibit .2.  The approved or the certified minutes of the June 8, 2010
meeting as Exhibit .3.  And the summary of ethics rules for non-federal
individuals that accompanied Mr. Sadler's presentation is Exhibit .4.

		CHAIRMAN SILVERSTEIN:  Okay, anything else Sarah?

		MS. SHORTALL:  Not at this time.

		CHAIRMAN SILVERSTEIN:  Okay.  Before calling Dr. Howard up for an
update from NIOSH, I just want to go over the materials we have for
today.  Everyone should have a copy of the minutes.  You all had an
opportunity to look at those previously, but I will ask you whether or
not there were any additions, corrections, problems that were not noted
earlier?  They have been signed and certified, but one opportunity to
make any comments.

		(No response.)

		CHAIRMAN SILVERSTEIN:  You will find in your packet materials that
accompany a couple of the discussions.  And I think we'll go over those
as each item in the agenda comes up.  You should have in addition to the
items that are actually in the folder there are three or four other
documents that OSHA wanted us to have that I think are at your desk.

		There is a document entitled OSHA at 40, which was a paper that Dr.
Michaels released a few weeks ago.  There's a copy of the letter to
Grain Storage Facility Operators that OSHA and many of the states sent
out a few weeks ago.  There is a statement from Dr. Michaels on long
work hours and a letter that OSHA sent out on cleaning fuel-gas piping
systems.

		I just want to be sure everybody did receive a copy of all of those. 
There is a booklet entitled Safety and Health Awareness for Oil Spill
Cleanup Workers and a set of three cards in languages other than
English.

		MS. SHORTALL:  Spanish, English, and Vietnamese.

		MS. SEMINARIO:  We don't have the letters that you spoke about that
had come out.

		CHAIRMAN SILVERSTEIN:  That's why I mentioned it.  I wasn't sure if
they got out or not.

		MS. SEMINARIO:  We have those booklets.  We don't have the letters
that were sent out.

		CHAIRMAN SILVERSTEIN:  Okay.

		MS. SEMINARIO:  One comment?

		CHAIRMAN SILVERSTEIN:  Yes, Peg Seminario.

		MS. SEMINARIO:  I would just say that it would be very helpful if we
could get, not all of the materials, but some of the materials
pertaining to the agenda beforehand by way of background because it
makes it really difficult to do any preparatory work and thought.  And
if we're going to be providing advice and not just listening to
presentations, having the information in advance would be really, really
helpful.

		CHAIRMAN SILVERSTEIN:  I agree with that, Peg.  And one of the things
that I am learning very quickly is the need for me to spend a bit more
time with senior OSHA staff in a couple of weeks prior to the meeting so
we can take care of those things.

		MS. SEMINARIO:  Okay.

		CHAIRMAN SILVERSTEIN:  And I will definitely do that in the future.

		MS. SEMINARIO:  And I would just also ask if you want to then solicit
from folks if they have other materials that they'd like to offer as
well that would be a useful time to do it beforehand.  And I know that
right now the timing of this meeting makes it difficult because trying
to get anything done during August was like impossible.  I appreciate
that.  But for the future meetings that would be most helpful.

		CHAIRMAN SILVERSTEIN:  Difficult, not impossible.  And I will take
your suggestions seriously and we will do better in that regard.

		Any other preparatory comments?

		(No response.)

		CHAIRMAN SILVERSTEIN:  Then I'd like to call up Dr. Howard for an
update on NIOSH activities.  You'll see that Dr. Howard is on the agenda
at two other times during the course of the day.  A little bit later
he'll be joined by Debbie Berkowitz to talk about Gulf Oil spill
response.  And then later on there's another NIOSH agenda item dealing
with influenza.  But now Dr. Howard.

		DR. HOWARD:  Thank you very much Dr. Silverstein and welcome
everybody to the neighborhood.  It's a beautiful day today, primary day
in the District and I believe in Maryland, too.  So we have quite a
mayoral race going on here in Washington, so it's an exciting day.

		Thank you all for coming.  We really appreciate at NACOSH all advice,
whether we like it or not.  And so please feel free to comment and give
us lots of good advice.

		The last NACOSH meeting I had mentioned three topics.  One, social
media; two, prevention through design; and three, H1N1.  So we're going
to have a special presentation on H1N1 and there's a lot of issues
there, as some of you know.  And we're really welcome all of your
thoughts on how we handle the next seasonal influenza outbreak, which
will be upon us soon and how we prepare best for H1N1, which is the
Avian influenza that we hope never appears.

		We also have, as Michael mentioned, a special little panel here on
Gulf Oil, so I won't mention any of those things.  I'll save that.  But
the last item for advice I think is really important is anything that
you see that are interactions between NIOSH and OSHA that are not
occurring that need to occur, or interactions that are occurring, but
are not that productive from your standpoint.  I think that's an
important bit of advice that we always seek because folks give us ideas
about how to interact with OSHA that sometimes we haven't thought of. 
So that, I think, is extremely helpful.

		On the budget issue, No. 1 issue, we don't have one yet.  And
apparently, we may or may not have one by the September 30 date.  I was
thinking the other day I really can't remember in the last few years
when we've had a budget actually on October 1, the beginning of the
federal fiscal year.  But we're always hopeful and hope that that comes
to pass and NIOSH resources at least remain stable if not replenished.

		NIOSH is also watching as a second congressional legislative issue the
movement of the World Trade Center Program bill.  At NIOSH, of course,
we're very anxious to see an actual authorizing legislation.  We've had
appropriations for that program, but we'd really love to see
authorization from Congress that will give us specific guidance on how
we should conduct that program.  So we're looking forward to that.

		I just want to mention a couple CDC issues. One issue is that CDC is
in the process of creating or projecting strategic projections for this
$14 billion organization.  And obviously, NIOSH is a part of CDC but
it's not the tail that wags the dog.  So I'm going to read off a couple
of these strategic directions that CDC is working on and plans to work
to work on for the next year or so.

		And I think what I'll do is we'll highlight where we feel that we can
make a contribution from the occupational side.  One is healthcare
associated infections.  This is a serious issue in medical care, et
cetera.  And obviously, a healthcare worker is involved to some extent
in that.

		HIV is a longstanding issue at CDC, obesity, nutritional issues,
physical activity are also important issues.  Food safety is an
important issue that CDC works with FDA on, and there's been a lot of
issues related to food safety.  Teen pregnancy is another important
issue for CDC.  Tobacco is an important issue.

		Environmental health, per say, we have a new director of -- associate
director of ATSGH and director of the National Center for Environmental
Health, Chris Poiterioirer, who is formally of the National Institute
for Environmental Health Sciences and a former associate administrator
of the National Toxicology Program.  So Chris just joined CDC in the
last month.  We're looking forward to some good collaborations with him.

		Immunization is an important issue for CDC, as you can imagine.  And
it does impact, obviously, as we'll talk about in seasonal influenza the
issue of vaccination for flu.  Preparedness is an important issue,
strategic direction for CDC and obviously global collaborations.  And in
that area, the global efforts at CDC are directed chiefly at HIV and
polio in that regard.

		The last direction is one that we have contributed significant effort
in, and we hope to continue in this area.  The strategic direction is
motor vehicle injuries and accident and fatalities.

		As we all know, motor vehicles accidents are the leading cause of
occupational fatality.  So we feel that we have a lot to contribute
here.  We have a NIOSH sector program in Transportation.  So we think
this will be very synergistic with CDC declaring this as one of their 12
strategic goals.

		So I think those we'll look through time.  CDC maybe looking at how to
align budgetary resources to these strategic directions, so we'll see
how that works out.

		One other issue that I wanted to mention with regard to the strong
support that we have with Dr. Friedan, the CDC director, concerns the
elimination of Black Lung disease or Coalworker's Pneumoconiosis.  This
obviously involves more the Mine Safety and Health Administration that
we also are joined with them in statute in the Mine Safety & Health Act
of 1977.  And we're working with them on a number of different things
and updating our 1995 criteria document, which actually recommended a
REL for coal-mine dust.

		We have a mobile van that does x-ray examinations for miners.  We have
our personal desk monitor that measures the coal dust in the mines in
real time, et cetera.  What has been very positive is Dr. Friedan's
interest in creating a campaign around Black Lung elimination.  So we're
very happy that we can have that interest and his also interest in
involving Cat Silverstein at OIRA in supporting this as a public health
issue.  So that, I think, is an important activity that we're involved
in with CDC support.

		The next major activity -- I just want to mention two OSHA-related
issues that I think are worth talking about, and I'm sure Dr. Michaels
and others from OSHA will talk about it also.  But on the 3rd of
September NIOSH response to an OSHA request to look at 15 candidate
chemical substances that are proposed for OSHA PEL development: 
Perchloroethylene, Hexane, Isocyanate, Manganese, Styrene, Toluene,
Acetone, Carbon Monoxide, Diesel, Mercury, n-Propyl Bromide,
Glutaraldehyde, anesthetic gases as a class, chemotherapeutics and
welding fumes.

		We added one more, Trichloroethylene, to the list and sent back to
OSHA all of our information to help OSHA in their efforts in this area. 
As you know that's a major issue for OSHA that you'll hear about and
have heard about and we're trying to support them as much as possible in
that area.

		Secondly, we entered into an interagency agreement, specifically on
Nano.  As you know, this is a major area in NIOSH and we have been
trying to interest OSHA in this area and finally have a very receptive
assistant secretary in Dr. Michaels in this area.

		So we've done an interagency agreement to look at control banding and
prevention through design principles for the manufacture and use of
engineered Nano materials.  So we'll be leading this effort.  The
objective, obviously, is to design and contribute to control risk
management strategies and guidance materials and others that we hope
then can be co-branded and produce a large impact in this emerging area.
 So we're very happy about that.

		There is some science updates that I wanted to give you.  The first
one has to do with quantitative risk assessments that are in the
planning stage.  We've just started a new quantitative risk assessments
and some draft criteria documents for Formaldehyde, Diethanolamine,
Benzene and Toluene Diisocyanate.

		We're also going to be looking and reexamining, if you will, and
updating the quantitative risk assessment issues and the scientific
literature on metal-working fluids.  As you know, this was a major topic
in the late nineties, I believe.  So we're going to look at that again,
do a new hazard review.  And we're also looking at lead.

		And most importantly, I think, for us in NIOSH is several aspects of
work hours and shift work. As you know, and as we'll talk about later on
this was a significant issue in the Deep Water Horizon response and is
an issue across a lot of different industries. The science, if you will,
of fatigue, even though it's kind of a fuzzy word has really started
advancing in terms of finally recognizing that the human being is a
biological entity and not a machine.  And therefore there are fatigue
issues associated with work.

		The Europeans, of course, lead in this area.  And I think it's
important for us to look at our issues.  It does tend to -- honestly, it
does tend to scare employees to be talking about this issue.  And it's
difficult, but we want to look at the science and see where we are at
this point in time on those issues.

		We have some criteria documents and current intelligence bulletins
that we're working on, criteria documents for Hexovalent Chromium,
Glutaraldehyde, 1-Bromopropane, and Diacetyl.  We have some current
intelligence bulletins that we're working on for Titanium Dioxide, for
Carbon Nanotubials and Manganese and welding fumes are underway.  And
we'll talk about what publications have resulted so far.

		In our food-flavoring related lung diseases issue, I first have to
thank OSHA and compliment them on their patience and forbearance with us
in getting risk assessment data to OSHA for their rulemaking in food
flavoring.  The generation of our data involves very small cohorts of
folks that we have an ethical obligation to protect their identity.  And
this is difficult with regard to risk assessment where a risk assessment
package that OSHA would do in its rule must be fully vetted publicly and
is available and so people can recalculate and that sort of thing.

		So protecting the identities of the individuals that participated in
our studies and yet be able to provide OSHA with the information they
need has taken a little more time than I think than we would have wanted
and I want to thank OSHA for their patience.  But I think we're on the
right track and we're getting all of that work together, both on
Diacetyl as well as other food flavorings, such as Pentanedione, which
has lately come to the fore as another food flavoring that may have the
same respiratory toxic affects as Diacetyl.

		One other issue I wanted to mention in terms of evolving issues
scientifically is an interesting issue with regard to Indium Tin Oxide,
which some of you say, well, where do we see that?  It's actually in
that flat panel TV and it's probably in your TV.  And it's in conductive
touch pads and all sorts of other things.  And it's an emerging
occupational issue.

		In March of this year, NIOSH investigators published a report
describing two Indium Tin Oxide workers at one facility with a fairly
rare disease.  And of course, in epidemiology it's always easier to find
the very rare diseases because they stand out.  And this is a disease
that's called Alveolar Proteinosis, which essentially a disease where
the terminal airways or the air sacks in the lungs fill up with protein
that should not be there and obviously there's no more room for gas
exchange in that air sack.  It's a very serious disease.

		And then we were contacted then subsequently by some Asian
investigators who have seen similar cases.  And for those of you that
follow the flat panel TV market, you'll know that most of the flat panel
TVs are made in Asia.  They're not made here in the United States in a
large proportion of the market.

		So on Monday and Tuesday of this week, we are holding a workshop in
Morgantown that's going to bring together Japanese and Chinese, Korean,
U.S. investigators to look at this issue, to identify practices and to
see where we're at with this emerging issue.

		As some of you know who follow the rare earth metals and perhaps
dabble in investment in this area because they are a very serious issue,
they are being used up quite a bit in the world markets and there's just
not that many of them, hence the name rare earth.  So Indium is one of
those and it's a serious issue that we're looking at.

		A couple of science process updates I wanted to give you.  One has to
do with the electronic medical record.  And this is a complex area.  But
it's one that for us in the Department of Health and Human Services that
a lot of resources are being spent on.  The budget for the national
coordinator health information technology went from $60 million last
year to $2 billion.  This is a pivotal issue in health reform.  A lot of
researchers believe that administrative costs can be saved by the use of
an electronic medical record.

		Now to make an electronic medical record, it's a very complicated
process and it involves significant advisory committees in the
Department that then have to -- to require something in the electronic
medical record or to put it in the medical record it has to pass through
this very narrow test called 'meaningful use.'  It has to be meaningful
to a clinician who's filling out the electronic medical record.

		Now for us in public health, we would love to see a lot of things on
the electronic medical record.  We'd like to see occupation and we'd
like to see all sorts of things.  But it has to pass this test of
meaningful use to a clinician.

		Now what we're trying to do in NIOSH, and we have a team that's
working on that with CDC and with HHS folks on the meaningful use of
electronic medical records.  And we've met with David Blumenthal, who's
the national coordinator is we're trying to get Canada projects that
could demonstrate the usefulness or how meaningful having a field on
there.

		For instance, a person who comes to a clinician with asthma, well, it
may be very meaningful for the clinician to know what are your
occupational exposures.  Clearly, if you're a clinician and you're
treating somebody with asthma and you're asking them about their cats
and that sort of thing, but you're not asking them what kind of work
they do you may have a patient with seemingly recalcitrant asthma to
your therapy because you're not dealing with the occupational side.  So
that would be a strong argument to adding that to the electronic medical
record.

		So we're looking at Canada issues like that.  And as I say, be happy
to be discuss that further and get our experts to give you -- but it is
an important issue because it does relate to expanding the issue of
surveilling what kind of data is being collected in the U.S. and
figuring out how we in occupational health can make use of this big
train that's moving down the track with a lot of money attached to it.

	The second process issue I wanted to mention is the transition of our
chest radiography surveillance, which we do for lots of different
diseases, including Black Lung from the old film that you put up with
silver in it and all that.  You've seen those on TV.  I always like it
on TV because they always turn the thing -- the heart is usually upside
down or it's facing the wrong way or something.

		But we're transitioning from the flat, plain film to digital
radiography.  So the clinical world has done that for many years.  And
through a lot of work by our Division of Respiratory Disease Studies,
working with the International Labor Office that establishes the
B-reader system and the ILO system for looking at x-rays for
occupational purposes we've done three publications that highlight that
and we're aggressively moving forward to incorporate digital radiography
in our Coworkers Surveillance Program, our B-reader Certification
Program, et cetera.

		The next process issue I wanted to mention is the Ryan White HIV/Aides
Treatment Extension Act of 2009.  This is an act that passed last year. 
And in Part G of that act, which is entitled Notification of Possible
Exposure to Infectious Diseases.  It states that not later than 180 days
after the date of this enactment the Secretary of HHS has to complete a
list of potentially life-treating infectious disease, emerging
infectious diseases to which an emergency responder could be exposed
during an emergency.

		Some guidelines then describing the circumstances in which the
employee -- the emergency responder may be exposes, the various
conditions.  And then how the medical facility should make
determinations that exposure took place because you want to then go back
to the individual responder and say you transported somebody that had
Anthrax, by the way, last week so that you can do necessary follow up.

		So we have been working on our list and I'm told by Frank Hearl that
it will shortly be published in the Federal Register so everybody can
look at it and see whether we have the right diseases on it.  And then
it's the responsibility of health departments and hospitals and
emergency response organizations then to implement that list.  So that
is I think an important issue you may have some questions on.

		A couple of other things just shortly I wanted to mention.  One is our
Youth Education Project.  We, as you know, have curriculum for all
states -- actually a new version of our 51 versions that are on the
website for curriculum for safety and health for high school students. 
And we're just adding a Washington, D.C. version of youth at work
curriculum.  So we're kind of excited about that.

		And we're looking to award a contract to the Labor Education and
Research Center at the University of Oregon to explore multiple options
that would help us integrate the curriculum into vocational high schools
and other high schools within the State of Oregon.  So we're happy about
that.

		Publication-wise, we're going to have a CD for you a little later. 
Our little batch didn't arrive on time, but we're going to have it by
the time you leave the meeting.  On that will be a newly published
publication that we're highlight.

		As you know, in 2004, we did an alert called Preventing Occupational
Exposure to Anti-Neoplastic and Other Hazardous Drugs in Healthcare
Settings.  As a part of that alert, there's a list of hazardous drugs. 
And that list has been updated recently for 2010 and that's on our
website, but we'll have that for you on our CD.

		The publications that are expected, and some of these have been
expected for a while, is one our NIOSH alert on Beryllium sensitization
and Chronic Beryllium Disease.  And second is our current intelligence
bulletin on asbestos fibers.  And Paul Middendorf is our
editor-and-chief of that and I think is probably as anxious as I am to
see a publication of that so we can get on with the research that the
publication sets out.  So those are expected, hopefully, by the end of
the year.

		We have some drafts that are published for comments on our website. 
One is our skin notations profile.  The other is our recommended
standard for 1-Bromopropane and a current intelligence bulletin for
Titanium Dioxide.  So those are already on.

		In terms of global collaborations, I wanted to mention that we're
hosting two physicians from Afghanistan who worked for the Afghanistan
Ministry of Public Health and the Afghan Public Health Institute.
They're coming to NIOSH October 9 through the November 4.

		These two physicians are working with NIOSH to introduce occupational
safety and health issues to the Afghan public health infrastructure,
chiefly in the areas primarily of agricultural workers, which both
America and Afghanistan are trying to make an infrastructure investment.
 And so they're going to spend a month with us and we're excited about
having them here for training.

		The last thing I wanted to mention is that it's finally happened.  I
certainly never thought it would ever happen, but if you do enter
NIOSH.gov on any URL the NIOSH website will come up.  This has been a
longstanding goal of ours and I really have to thank Ken McNealy who is
our IT guru for getting it to happen.

		Now when it appears, the URL will appear on your browser
www.CDC.gov\NIOSH.  We haven't gotten that far, but for those folks that
are looking for NIOSH they can enter it and it will pop up.  So I think
that will help a lot of users who aren't the Cota Shenty of NIOSH and
OSHA, but rather are just looking for some basic information and know
the NIOSH name, et cetera.  So we consider that to be a battle well won
and we're very happy about that.

		So I think I'm going to end there and open it for comments and
questions and advice and all sorts of good stuff.  Thanks.

		CHAIRMAN SILVERSTEIN:  Thank you, John.

		Peg would like to start.

		MS. SEMINARIO:  So much to talk about here. First, I want to thank you
for that very comprehensive overview, and particularly thank you for all
the good work that NIOSH has done in setting up and carrying out the 911
health program.  Just as a point of personal privileges this is a
program that I've worked very closely on for years and it's one that is
a reminder of the fact that there are major occupational health risks
involved in all kinds of responses.

		And currently, we've got 15,000 responders and community members who
are quite sick as a result of exposures from their work or their
proximity to the World Trade Center.  And so trying to get this done on
a permanent basis is important to all of us.  So thank for your efforts
there.

		One of the areas that you didn't mentioned, and looking forward,
looking out to what I see as probably being a major issue, and it's one
that I know NIOSH has done work on and that has to do with the aging
workforce.  There's a lot of discussion going on right now around
deficit, possible recommendations for changes in social security
eligibility.

		And clearly, for all of us who work in this area are quite cognizant
of the fact that you said the human body isn't a machine.  It's a
biological system that has limitations.  And as a representative of
workers, very cognizant that we have a lot of disability, injury,
disease in younger workers, but particularly as people get older I mean
they just can't do these jobs and would ask you think about and also for
OSHA to think about the implications of people working longer.

		And first of all, the kind of work that needs to be done just
currently to give some assessment of what that demographic is, what we
know about exposures, disability, injury rates, et cetera, amongst older
workers because I can see a lot of this happening very quickly if there
are decisions, recommendations mad.  And having some background that
helps inform the discussions on that I think would be quite helpful.

		I'm not asking you at this point in time to go out and do a lot of
research, but I am suggesting it would be a very useful activity for
both NIOSH, OSHA as well as BLS to put together that information at this
point in time and so it is available and so some of the issues that are
related to some of the policy decisions that may be made is available to
the decision makers because it's something that obviously people have
somewhere in the back of their minds.  But unless they're really
involved in work and workplaces, it's not something that is readily
apparent to a large number of people.

		DR. HOWARD:  This is music to my ears because our Work Life Program
has a major emphasis in the aging workforce.  And so I think that your
recommendation for us to consider the implications of people working
longer more formally I think is well taken, especially with the three
occupational, safety and health agencies -- OSHA, NIOSH and BLS.

		For us in NIOSH, in our Work Life Program, we are developing
relationships to be able to prepare a series of policy recommendations
from the safety and health perspective.  Yesterday, I met with the
National Institute on Aging in Bethesda to try to figure out how their
-- they fund about $150 million in aging American workforce -- not
workforce, but aging Americans and then how much of their portfolio
actually relates to work.

		One of the most interesting studies that they funded, which appeared
in the Journal of Economic Perspectives, which is a journal that I don't
usually read, and it's entitled Mental Retirement.  And what's
fascinating about that because we talk about some of the negative
implications to safety and health issues related to muscular skeletal
work and others as well as the serious policy issue of extending
retirement age, which sounds and may not be that much of an issue for
folks in white collar jobs, but is a real issues for folks who have much
physically-demanding work.

		All of a sudden you tell them, well, you're not going to retire at
this age.  You're going to retire three or four years later.  In fact,
there was an article in the New York Times the other day about that.  In
addition to all those policy things, we tend to think in the negative,
but this is actually a positive.  I was struck by this study about what
happens when people retire early that they're actual cognitive
limitation onset comes earlier than a cohort peer group.  So there is
some positive, but the question is there's a lot of negative.

		So I think we want to look at both the positive side and the negative
side of the aging workforce implication.  So I would love to be able, if
the committee is interested, to be able to tell you what you're doing in
the Work Life Program and what we're doing on the aging workforce issues
because we do have three Work Life Centers that we fund.  One is at the
University of Iowa.  The other is the New England Center, which is a
combination of the University of Connecticut and the University of
Massachusetts at Lowell.  And then the third center is at Harvard.

		And we also, even though we don't fund it, we're in collaboration with
the Veterans Administration.  Their Director of Environmental and
Occupational Health, Michael Hodgson, is a former NIOSH and he has a
very large Work Life Program for the 174 facilities that the VA has. 
And we're also working with OPM and OMB on federal workforce
demonstration areas.  So there's a lot to talk about if the committee
was interested in pursuing this.

		So I thank you for bringing that up.  I didn't put it in my remarks
because I tend to get a little carried away with this topic because it
really is to me a demographic demand that we have to look at carefully. 
In the Congress right now, there are at least three or four bills that
talk about extending retirement age, keeping federal workers on, et
cetera, et cetera.  And in none of that is there really any safety and
health issues and I think you've identified a serious gap that we need
to fill.

		One of the issues that I just want to mention that I think we have a
role to play at NIOSH is in the meeting with National Institute on Aging
folks they are essentially providing the funds to conduct the scientific
research, but they can't make recommendations.  So they don't really
have a channel to bring all of that science that they're paying for into
the recommendation outcome.  So I think that's where we could have a
good relationship.

		CHAIRMAN SILVERSTEIN:  Bill Buchan had his hand up first.

		MR. BUCHAN:  Dr. Howard, you mentioned that the Afghans are coming
over.

		DR. HOWARD:  Two of them.

		MR. BUCHAN:  Pardon me?

		DR. HOWARD:  Two of them.

		MR. BUCHAN:  Two of them.  You're going to emphasize agriculture.

		DR. HOWARD:  That's their interest.

		MR. BUCHAN:  That's their interest.  Okay.  Well, that pleases me
anyway.  As you know, I've been working in that area since 1973.

		This country really has not placed an emphasis on agriculture, other
than what NIOSH is currently doing.  OSHA has been restricted
legislatively and also writers on appropriations bills to go into
agricultural operations.

		The one thing that I see is really missing.  We do research in AG
health and safety.  There is really no outreach, education or on-site
intervention where it's really needed.  And I think the Afghans need to
know that that's an important aspect of occupational safety and health
in that arena.

		DR. HOWARD:  Sure.  And I think that we'll be able to help them out in
that area.  Also, again, if the committee is interested, we fund 10
agricultural safety and health centers throughout the United States.

		MR. BUCHAN:  No, it's seven.

		DR. HOWARD:  Seven.  But we have three others that we're working on. 
And so those centers I think do a good job at the mission of outreach
and education.  So I'm not sure I would agree that there's nothing going
on.  Things can always improve I think.

		MR. BUCHAN:  A minimum.

		DR. HOWARD:  Right.  Well, minimum is in the eye of the beholder.  I
think they're doing a great job in what they're -- the money that we
give them.  I think that that's always the issue.  Outreach is really
dependent on how much resource you can make available.  And I certainly
think that we would want to make more resources available to them.  But
again, that's an area that we don't have that much of a reflection on
the OSHA side with for obvious reasons.  But again, if the committee is
interested in that aspect of our work, we'd be happy to do that.

		MR. BUCHAN:  I didn't mean to criticize NIOSH in the AG work they're
doing.  I just think it's a minimal investment considering the magnitude
of the problem.

		DR. HOWARD:  Sure.  I think the AG center directors would probably
agree with you.

		CHAIRMAN SILVERSTEIN:  Bill Borwegen.

		MR. BORWEGEN:  Dr. Howard, thanks for an excellent, comprehensive
presentation, wetting our appetites in a number of areas.

		I had a question about the medical records.  This is obviously a very
interesting opportunity to identify occupational health concerns among
patients.  Is there a way so that -- this is going to be electronic.  So
is there a way that symptoms could trigger more detailed questions about
working exposures.  So the question is when you answer yes to a certain
question like do you have asthma, can the electronic system drill down
versus going on to the next question?

		DR. HOWARD:  Right.  It's a record for the physician, not for the
patient.  So it's not like a symptom survey or something like that that
you would give to a patient.  That's entirely within the purview of the
clinician.  But rather it's a record that the physician fills out.

		MR. BORWEGEN:  I see.

		DR. HOWARD:  It has nothing to do with the patient directly in that
sense.

		MR. BORWEGEN:  Do you think you're going to be able to get any
questions onto this timeframe?

		DR. HOWARD:  Well, we certainly are going to try.  You know, I think
this is a difficult area.  The electronic medical record for physicians
throughout the United States is not a gee whiz let me just get out that
record.  I just can't wait to fill out an electronic medical record that
government came up with.

		So there's a lot of resistant to this and it's a very prolonged,
protracted process and the criteria that's being used is the meaningful
use criteria.  Unless clinicians think that it can enhance their care of
the patient, they don't want to fill out some government form that has
extraneous information.  Unfortunately, for us in public health what we
consider to be extraneous -- what they consider to be extraneous we
consider to be extremely important, surveillance information.

		MR. BORWEGEN:  And I assume ACON and others are weighing on this.

		DR. HOWARD:  Yes.  Everybody is involved in this that has anything to
do with the medical profession.

		MR. BORWEGEN:  Okay.  A couple of other points.  Just responding to
our comments about the aging workforce, it would be nice for NIOSH if
you could look into what is going on with the safe patient handling laws
that are passed around the country where nurses are getting older and
patients are getting heavier.  And we're starting to see some initial
results.  I know in Washington State, Dr. Barbara Silverstein has
results there.  But New Jersey, Minnesota, other states that have
implemented laws I think it would be useful for NIOSH to add this to
their webpage, links to some of these state laws on safe patient
handling or for instance either linked to the New York State Public
Employee Workplace Violence Prevention Law.  I think it would give
examples to others on what states have done, concerning that for the
last recent years states have been leaders in passing state legislation.
 I think it would be useful for others to see this kind of information.

		It would be nice to form maybe some type of internal or external
workgroup to see what NIOSH could do in the way of perhaps an alert or
some other type of publication on the issue of safe patient handling
because I think the alert you did on hazardous drugs was very useful and
can we do something now on -- knowing the excellent work that Dr.
Collins and others at NIOSH have done documenting that these programs
are incredibly economic -- they say back and bucks is what I say.  And I
mean if it was an investment on Wall Street it would be like the best
investment there is.

		You invest this money and then you save money, not only the first year
but subsequent years on these safe patient handling program.  How do we
highlight that?  You were talking about a lot of different documents
coming out, but I'd like to see how do we put that in a nutshell into a
document that would really create some -- I know you've done some
already in this area, but how would we create a bigger splash for -- a
bigger bang for the buck?

		In the area of Glutaraldehyde I'm glad that's on the list, both on
this PEL list and also a criteria document.  Just the fact that you're
looking at Glutaraldehyde more closely means that there's going to be a
tendency that they're going to move towards using an alternative called
OPA and we don't know if OPA is a safer chemical.  So I would urge you
to simultaneously look at OPA as you look at Glutaraldehyde to see are
is the alternate safer than Glutaraldehyde because we don't know that
and we're getting mixed information.  So that's my third and final
comment.

		I'd like to see the Ryan White language, but I can look at it on the
Internet.

		DR. HOWARD:  Not yet.

		MR. BORWEGEN:  I just want to read Section G right now.  I think you
for alerting us to that.  That looks like it might be a useful hook for
a number of reasons.

		CHAIRMAN SILVERSTEIN:  Linda Rae Murray.

		MS. MURRAY:  Well, thank you, John.  As always, you're a gentleman.

		Let me just say that at some point it would be nice to have some sense
of NIOSH's strategic direction buried at CDC.  And I will here be
critical of CDC as a local health officer I am more than -- CDC is a
major source of frustration for me.  But this listing of solo activities
is not a strategic plan.  Let me just say that.

		But what I really wanted to comment on actually was the electronic
health record because -- and I think NIOSH can help us a great deal in
this area.

		If you have a notion of public health as separate disconnected
campaigns, which is often what I think CDC thinks public health is, then
how you describe the electronic health record and our present efforts in
this effort fall into that category.  That's not how I would describe
it.

		First, I still see patients and I use an electronic health record and
it's not where it needs to be.  So it's not magic.  It's not like on
Star Trek or anything yet.  And it is fundamentally a clinical, as
you've describe it, interaction between the provider and individual
patient.  However, I think that how you describe meaningful use is a
narrow, clinician definition.  I agree.  It's the dominate way it's
discussed and it misses the public health implications.  This
technology, electronic health record is the least of it.  That's the
interface that the doctor fills out.

		Right now, if I go into any hospital in this city, they'll have for
any patient next of kin.  They'll have the address.  They'll have the
zip code. They'll have where they work because they'll have the
insurance.

		DR. HOWARD:  Is there any reason they actually know where they work?

		MS. MURRAY:  No, they won't have what department they work in.  So
what's the really powerful thing that public health needs to be
concerned about and we in public health need to be defining meaningful
use.  And it's easier for us in health and safety than in many other
areas of public health is that we now have a centralized database
through these health information exchanges, which I know the economists
think the different hospitals will put information and they won't repeat
a test or an x-ray.  That's their theory behind it.  We'll probably
still repeat the x-ray, but that's all right.  We won't tell them that.

		But there are so many other sources of information that could be put
in a health information exchange that would allow us in public health to
engage in active surveillance.  For example, where people are working. 
If we have the ability to know that people at -- and don't forget most
of our companies are small.  At XYZ Plating Company that employs 100
people in the past ten years and we see a pattern of something that's
really powerful, whether or not the individual clinician learns how to
take an occupational history.

		If I knew where the foreclosed houses were in my community and what
communities had higher rates of foreclosures, I'm betting I could
predict we would have higher rates of strokes and heart attacks, but I
certainly would like an opportunity to test that hypothesis.  So I would
call on NIOSH and OSHA and other components of public health at the
federal level to begin to get away from this clinical approach.  I mean
I'm willing to have a clinical discussion with anyone.  I'm a clinician.
 I don't mind that.  But ask ourselves what population-based information
do we need in these health information exchanges.

		If I knew what the age of houses were in my community, and easily
there, and that could be tagged to children that were being seen by the
doctor, that's a big clue of where my childhood lead poisonings are
going to be.  So we really have to have a public health population eye
towards this, not just an individual-focused clinical eye.

		And what does this mean in English?  I think it may mean, for example,
requiring for OSHA that companies with the ability maybe they need to
file in the HIEs what departments people are working in so that we can,
in fact, begin to track lifelong exposures.

		So the technology that exist today that didn't exist 10 years ago or
20 years ago, and it will evolve will give us a lot of tools that we
don't now have.  And because the country is focused on trying to save
money in medical care, we can use the medical care backbone that's being
built to, in fact, allow us to make different kinds of advances to
protect workers.

		So my challenge to NIOSH and OSHA is this is not just a get on the
bandwagon.  I think this is a really major tool.  It will not help
clinicians that much.  We still practice medicine the old fashion way. 
I'm going to sit there and what I know I'm going to ask the patient and
I'm going to treat them.  But it will advance public health if we do
right because then we can actually being to have some science-based
population-based approaches.

		So I have not seen a major, national meetings called on public health,
except for the traditional communicable disease meaningful use things. 
I know locally in our health department we are trying to think about
some meaningful use cases for our local health department.  But I think
this should go on at the national level.  And I think in health and
safety and environment where we have other databases.  They may not be
quite the way we want, but we have existing databases now.  We force
people to keep MSDS sheets now.  What if we force them to keep them
electronically?  And what is there was some way to match them up where
people worked?  I think we're missing a major opportunity to make
advances.  Because if we continue to just do 15 PELs every decade and
put out one or two criteria statements a quarter we'll be forever and
workers will continue to die.

		DR. HOWARD:  Certainly, you're very eloquent on this point, and
especially the point about public health needing to define meaningful
use because as we've been talking about the driver right now is what a
clinician thinks, per say.  So this is I think something that we are
very I think supportive of.

		Dr. Eileen Story is our representative for all of these committees. 
So what I'm going to do is take your messages back to Eileen who I'm
sure they will resonate with and I think she's trying to do some of the
same things that you're recommending.  And maybe she can get in touch
with you and figure out how the public health voice can be a little
stronger in this very large effort that is driven, as we've said
primarily by the clinician field.

		But Eileen is no shrinking violet either and is trying to make the
very same arguments that you so eloquently made here.

		CHAIRMAN SILVERSTEIN:  Susan Randolph.

		DR. HOWARD:  And if I could ask Deborah, when the transcript is done
let me know so that we can capture Dr. Murray's comments.

		MS. CRAWFORD:  We will send the form to you.

		MS. RANDOLPH:  Thank you very much.  Susan Randolph.  I would just
echo what Linda Rae was saying about the individual versus
population-based records and the importance of having at least
occupation there.

		Granted, oftentimes clinicians, unless they have an occupational
background may not even associate that as being very valuable.  And I
think it goes back to training and education and why you need to ask
that question.

		The other issue with electronic medical records is that of
confidentiality.  And if they are electronic, who else has access to
those or if they're certain firewalls and how to keep some private
information private, but realizing the risk through surveillance an
opportunity to link certain information, but trying to keep the
important information confidential.

		DR. HOWARD:  Right.  And unfortunately, we don't have a couple of
hours to discuss the intersection of HIPAA and the meaningful use test
for the electronic medical record.

		MS. RANDOLPH:  Thank goodness.

		DR. HOWARD:  I was going to say thank God we don't have that time.

		CHAIRMAN SILVERSTEIN:  Peter Dooley.

		MR. DOOLEY:  Yes, Peter Dooley.

		Just a comment, John, on one of the issues that you raised, which was
work hours and fatigue and such.  Just as an urging about how much we
need to be doing research as well as intervention.  I've been doing a
lot of work in manufacturing recently that has really, really frightened
me about this whole doing more with less that is the national theme
these days in workplaces.  And the fact that the workers who are
remaining on jobs are being increasingly put on demands for extended
work hours and the health and safety implications of that I think are
really severe.

		People are really being pressured to do more work and they're being
pressured to report less injuries.  And the whole environment is
tremendously stressful in a way that we need to be really doing as much
intervention as much as we can as soon as we can.  Thank you.

		CHAIRMAN SILVERSTEIN:  Yes, John?

		MR. VAN HOUTEN:  Dr. Howard, three points that I wanted to comment on.
 The first is building on what Peter just said.

		At least in our company, we're seeing increased claims for workplace
stress and illnesses associated with workplace stress.  So I'm not sure
if NIOSH is looking at that, but it would be very helpful to examine
whether it's the economy or other stresses in life that are weighing on
people's shoulders, but it is spilling over into the workplace.

		DR. HOWARD:  Just before you jump to the second, the answer is very
definitely yes.  We have a Legacy Program, if you will, in work
organization and stress.  And we have probably internationally one of
the most famous researchers in that area Steve Sadder, who with Richard
Kerosac and a number of others have done the essential work on saying
just because a worker's stressed it's not necessarily because they  have
family problems or personal problems.  The work itself and how work is
organized and the pressures that someone has at work can be s source of
stress.  So this is pioneering scientist in this area.

		We have a number of publications.  We lead the Triennial Conference
with the American Psychological Association on Work and Stress.  So this
is an area that NIOSH as deep research and intervention involvement in.

		MR. VAN HOUTEN:  On the coping side, would you tie your health -- with
that reassuring message.

		(Laughter.)

		MS. SHORTALL:  Michael, that was the sheltered place announced
announcing as clear.  The reason why we didn't hear about the sheltered
place mostly likely is that the announcement is given over people's
computers at work.  But we were save because right over here are the
sheltered place supplies and this is a designated sheltered place area.

		MR. VAN HOUTEN:  What about the building service workers who don't
have a computer in front of them on their desks?

		MS. SHORTALL:  The building service workers?

		MR. VAN HOUTEN:  Well, how do they find out that you're doing a
sheltered place?

		MS. SHORTALL:  I don't know.

		MR. VAN HOUTEN:  Okay.

		CHAIRMAN SILVERSTEIN:  It's off the agenda, so let's pick up, Joe.

		DR. VAN HOUTEN:  I'm just going to return to my comment.  One of the
things we're looking at is improving or enhancing our health and
wellness programs to help people deal with stress, making access to
employee assistance programs that much more visible to employees.  So
it's just something that NIOSH is looking at from the standpoint of
helping employees deal with workplace stress, looking at the outlets
that help reduce that.

		DR. HOWARD:  The words that are used in the scientific literature is
'resiliency.'  The idea that we all suffer some traumatigens that we
encountered in work, life, et cetera.  But how resilient we are to be
able to handle that is really the issue.  How we build up resiliency. 
For instance, as we'll discuss later on in the Deep Water Horizon issue,
long hours, et cetera, how resilient are people to be able to handle
issues that face them.

		So that science of resiliency is a new area of research that a lot of
folks in occupational psychology are into now and so that replaces the
older term of 'coping' issue.  So yes, we are looking at that issue and
we have a number of folks that have published papers in that area.

		MR. VAN HOUTEN:  Thank you.

		Regarding electronic medical records, I have several comments.  One is
from the standpoint of a patient and caretaker of older parents that it
would be very helpful if we could have one repository for information
that physicians could access because personally I get tired of filling
out a medical history form every time I have to go to a new physician.
and I know I always forget information going from one physician to the
other.  So I think it would help my care if we had one repository.

		DR. HOWARD:  That idea has a lot of traction in the Department of
Defense military medical establishment where there are smart cards that
soldiers have that have all their medical history and all what's done on
their smart card.  So that idea is significantly being used military
medicine, but as yet in civilian it really hasn't taken hold.

		MR. VAN HOUTEN:  And from the occupational side, we see examples of
where having access to the employees medical history would be very
helpful in the occupational setting.  I use the term looking at the
holistic approach.  Ergonomics is one that comes to mind.  If somebody
is using their computer four hours at home and then they're coming to
work and working four hours on a computer at work, it would be nice to
know that they've got this kind of exposure on the job and off the job. 
So I'm not sure how that plays into electronic medical records, but
looking at the patient as an individual rather that on the job/off the
job is very helpful from an occupational health standpoint.

		DR. HOWARD:  Right.  And one of the reasons that this sort of issue of
electronic history hasn't caught on in the civilian side as it has in
the military, in the military you give up a lot of rights when you go to
work for the Army and the Navy and the Marines.

		On the civilian side there are issues related to what an employer is
entitled to know and it's a very complex area of confidentiality and et
cetera.  So it's a much deeper thicket of issues to go through on the
civilian side.  It's not to say that there aren't some compelling ideas
that one could discuss, but it is a more complicated area.

		MR. VAN HOUTEN:  The final comment I wanted to make was around motor
vehicle accidents injuries and fatalities.  It's a favorite of mine, as
you know. I'm very happy to see that CDC is stressing this as an area.

		I would be interested if you have comments or maybe OSHA has comments
later on about the coordination among government agencies on this
effort.  For instance, Secretary LaHood is sponsoring a symposium on
distracted driving next Tuesday and I'd like to know how does that tie
in with what OSHA and NIOSH are doing in this area.

		DR. HOWARD:  It's very interesting you mention that.  A few months ago
David Michaels and the NIOSH deputy, Dr. Kidd, attended a meeting at the
DOT on the issue of distracted driving, which is a huge issue for this
Administration.  And we're all participating, as we can, in that
distracted driver initiative.  So I don't know next week events.  There
are a number of events that are planned in this area.  There's a big
push on this area.

		So I can check back and we can get back to you about whether we're
involved in that effort.  Is it next Tuesday?

		MR. VAN HOUTEN:  Next Tuesday.

		DR. HOWARD:  Okay.

		MR. VAN HOUTEN:  That's the 21.

		CHAIRMAN SILVERSTEIN:  I'd like to put on table of couple of themes
that I hope we're going to come back repeatedly during the course of the
next two days.  And they're some things that you said Dr. Howard as well
as some of the panel members that I think lead us into these areas.

		The first is something that Linda Rae said earlier, which is that it's
important to distinguish between solo activities, all of which may be
interesting and important, and a strategic view that ties things
together and moves in a calculated direction.

		And I really feel that we have an obligation on this committee to
think strategically and so I want to introduce into the conversations
and I think that we become most useful to OSHA and NIOSH if we give some
help with strategical direction.

		While it may be useful to comment on very specific issues, I think
it's more useful to operate at a somewhat higher level and I want to
keep sure that we keep coming back to that.

		The second point I want to make is it's actually related.  I found
your presentation really informative and useful.  And in fact, I'm
impressed with the range of things that NIOSH is tackling and the
variety of areas that you're touching on.  And I find that I'm tempted
to ask for more details about a lot of it, and you offered to provide
more details.

		DR. HOWARD:  Sure.  Any time.

		CHAIRMAN SILVERSTEIN:  This committee could easily become one in which
we treat OSHA and NIOSH as learning institutions in which you're
providing us information and we're learning.  And I think all of us have
an appetite for knowledge, so it's a big temptation for us to ask for
more presentations.  I want to resist that temptation and turn the coin
over, if you will, because we're not here for our own education.

		I think we have an obligation and we're charged with providing the
agency with advice and making recommendations.  And so there are two
ways that we can go about that.  One is self-generated.  And I'm sure
that we're going to have discussion later in the course of today and
tomorrow in which we will generate some of our own ideas about ways that
we think we might be helpful to the agencies.

		But while you're here and tomorrow while Dr. Michaels is here I want
to ask you the question, put you on the spot a little bit and to ask for
your thoughts about some of the areas that you're working on or not
working on for that matter where you think that our advice may be
actually helpful to moving you ahead, helping you to make decisions or
choosing directions or deciding on resources allocations.  So if there
are some in the areas, either some of the ones you've mentioned already
or others where you think we might be particularly useful I'd like to
get that on a list of things so that we can make some choices before the
end of tomorrow.

		DR. HOWARD:  As I said in the last meeting, the three areas that I
pointed out was social, media, prevention through design, and H1N1.  Now
we're going to about H1N1 influenza, whatever you want to call it. 
We're going to talk about that later.

		And there are some impressing issues in that area that I think we all,
and I certainly would welcome any -- the learning thing I think that's
great.  But to emphasize the doing part and the advice part, but
sometimes you have to get a presentation about what the agency is doing
and we can certainly shorten those so that we can get to the tail end.

		CHAIRMAN SILVERSTEIN:  Don't misunderstand.  I think the presentation
was great.

		DR. HOWARD:  Some of this stuff is detailed and the EMR stuff is
extremely detailed, and all of these things are very detailed.  So we
would be happy to do shorter, 10 or 15 minute limit the presentation. 
Here's the basic stuff and it's a taking off point to discuss strategic
views and stuff.

		For NIOSH, we have a large strategic view of things because we have a
national occupational research agenda, which is a public/private
partnership, so we generate essentially new knowledge through the field
of occupation through that mechanism.  But I think today the comments on
the Deep Water Horizons are extremely important for us to be able to get
views and the H1N1.

		But as each member of the advisory committee offers their views, we
get some advice in that process.  We at least get are you for it or
against it.  We come up with a lot of ideas that somebody doesn't like
or they like.  So we get that right away.  That's basic advice.  And
since you all are very knowledgeable and you represent organizations,
that's important information.

		We have an interest.  We have some researchers that are interested,
and I personally am interested in the aging workforce issue.  But when I
first came up with the idea of the Work Life and all that, I though
nobody is going to like that because they're going to be very upset that
we're not spending the precious dollars we have on getting enough rails
done and why are you doing this other stuff that is worthless?  I turned
out to be wrong because people think it's worthwhile.

		So just having individuals on the committee comment about what we're
doing is extremely helpful.  Extremely helpful.

		CHAIRMAN SILVERSTEIN:  Good.  And I will not in any way discourage
individuals from continuing to throw ideas and suggestions at the
agencies.  I'm glad to hear that feedback.

		DR. HOWARD:  It's a rich experience for us.  I have on my list, and
I'm sure others from NIOSH are making their own list, five things right
away.  An alert on patient safety I never thought of that, but I will
take that back and see what people think.  That's an important thing.

		The issue about whether Dr. Story is getting her group around a public
health perspective on meaningful use.  There are lots of ideas that have
come out just this morning.  It's been very productive, so don't think
that it hasn't been.

		CHAIRMAN SILVERSTEIN:  No, I appreciate that feedback.  I do think
that advice, suggestions, recommendations that we can make you as a
group have a bit more power than individual suggestions.  And so as we
go on, I want to pool our ideas and move in that direction.

		DR. HOWARD:  If I could just comment on that because I still have,
because Deborah sent me a copy, of the letter that you all did on June
30.  And while we were going through the Deep Water Horizon event and
then just recently read it again to see what did we do n respect with
that.  And we'll talk about that later, but that was very valuable.

		CHAIRMAN SILVERSTEIN:  Yes.  Good.  And we will come back to that in
just a couple of minutes.  I just wanted to make one other comment and
then see if other committee members do, and then we'll move on to talk
about the Gulf issues.

		It struck me when I think Bill was talking a little bit earlier and we
started talking about the aging workforce.  I mean it struck me that the
world of work is substantially different in many ways than it was when
the OSHA Act was written and NIOSH and OSHA were charged with their
responsibilities.

		I mean not only have there been huge demographic changes of both age
and ethnicity, but there are also huge changes in the nature of
industry.  The distribution of work in different sectors is
fundamentally different than it was 40 years ago.  And then of course
there are exposures that exist now that were not anticipated by Congress
when it put together the Act.

		And so one of the things that I wonder about and I think this
committee might be well advised to look into is whether the deployment
of resources by OSHA and NIOSH match the current circumstances.  I know
within my own agency -- I'm responsible for a state OSHA program and I
think that in some ways we're locked into the past.  We've got a lot of
inspectors who are real good at doing construction inspections and that
what they do.  But we have almost nobody on staff who really knows how
to go into a healthcare facility and evaluate how to find and fix
hazards.  And so there's a real mismatch.

		And so I'd be really interested in seeing some information from NIOSH
and from OSHA about what your budget looks like, how you're deployed
resources so that we can maybe help you look at whether or not the way
that you're using the resources available to you to matches what the
needs are.  So for a future meeting, if there's a way that you can
present to us some basic information about where your dollars are, where
your people are that would be really very helpful to us.  Bill?

		MR. BORWEGEN:  Yes, if I could just embellish before you respond. 
I've always been struck by the mismatch between where OSHA spends their
time and energy and NIOSH and the BLS statistics on where people work
today and where they're getting injured and the reality that -- well,
it's kind of startling since the last meeting the reality that there are
more healthcare workers today than there are manufacturing workers in
this country.  There are 13.7 million healthcare and I think we're down
to 11.5 million manufacturing workers.  Yet, my understanding and I've
yet to find out if this has changed from decades ago that OSHA spend 85
percent of their inspections in manufacturing and construction.

		That number might be different now, but again how do we balance the
resource commitment to where people work today and where they're getting
injured.  I think that would be an interesting exercise to make sure
that the scarce resources that these two agencies have are being put to
the best use.

		DR. HOWARD:  Okay.

		MS. SEMINARIO:  Later on the agenda is an OSHA topic, but it's also
something that you had raised was an activity that NIOSH was engage is
the interaction of the agencies in dealing with rather than say
permissible exposure limits talk about exposure to chemicals.  It's
obviously a huge area that we've fallen way behind in.  And I think
looking at this issue is one that we may want to think about as a
committee, particularly with respect to the interaction of the agencies.

		And at maybe a future meeting to talk about not just the particular
projects that NIOSH is involved with OSHA on in providing data
information on particular standards, but again, the strategy.  What
should that relationship look like?  Who should have what
responsibility?  Should NIOSH have the responsibility?  I mean under the
statute if you go back and you read it what was envisioned was that
NIOSH would develop the recommendations for standards and then six
months later OSHA would have them in the Code of Federal Regulations and
obviously that hasn't happened.

		But I think going back and looking at that issue, and again the
resource questions, the resource issues, but to look at it around a
concrete program and area, particularly where NIOSH has background
history and expertise and to think about that and how these things fit
together.  And so I'd like to put that forward to get your reaction to
that.  And also put it to the committee as an area for future work.

		CHAIRMAN SILVERSTEIN:  Are there any other thoughts to wrap up this
part of the discussion from any of the committee members or John if you
have anything to add at this point.

		DR. HOWARD:  No.  As I said at the outset, how NIOSH and OSHA interact
is a very important issue for every stakeholder that I've ever talked
to.  Some of it is very opaque.  I think that's one of the problems. 
Now for all of you who are little closer to both the agencies that may
not be totally true.  But in general, people don't understand how the
two agencies work and how does the collaboration work.  Who calls who? 
That sort of thing.

		And I think some presentation about how we work together is great and
then how we can better work together and what areas that we're not
working in.

And I think we a have very receptive assistant secretary of OSHA who
wants to enhance the relationship.  We've always wanted to because we're
in a role of take our stuff and do something with it.  So we're on the
role trying to get more people paying attention because for us a chief
outcome measure is did it end up in a OSHA or MSHA policy?  Did it end
up in a reg or a rule?  That's a chief way that we assess how our
outcomes have worked.  We have other ways, but that's a chief way.

		So that would be great.  I think that's a central focus of us
strategically is can people suggest how better to do this.  For us it's
always a difficult issue because you don't want to be one of those pesky
partners who's always beating the door down and putting the agencies who
are responsible for these larger approaches in a difficult position
because then they develop an animosity to you.  So we always have to
calibrate how we approach OSHA and MSHA form our perspective.  We can't
be utterly pushy.

		But for instance, in the area of nanotechnology, I think a real
achievement is being able to have an interagency agreement on that. 
I've been talking to the last three assistant secretaries about getting
it.  So it's  a real achievement, but you have to know how to approach
it.

		CHAIRMAN SILVERSTEIN:  The point is really well taken.  When you
initially made the comment about the OSHA and NIOSH relationship I
starred that one and Peg brings it back in a specific context about
rulemaking, which I think has been an area where we have really failed
to meet congressional intent for a long time and it may be a possibility
to make some breakthroughs there.  So we'll keep that on the list for
discussion later today.

		Other comments before we move on to Gulf Oil issues?

		(No response.)

		CHAIRMAN SILVERSTEIN:  The next item on the agenda is an update on
Gulf Oil response.  We're interested in hearing where the agencies are,
what you've been doing as well as thoughts you've had about the
recommendations that we made to you.

		So I think Debbie you're going to come up and join John.

		MS. BERKOWITZ:  Yes.  We're a little early.  Do you want to take a
break now?

		CHAIRMAN SILVERSTEIN:  We could.  Would the committee like to take a
break now?  It would be a good time.  It's 10:15 now.  So we'll
reconvene for Gulf Oil at 10:30.	

		(Whereupon, a short recess was taken.)

		CHAIRMAN SILVERSTEIN:  Our next agenda item is a discussion about the
Gulf Oil spill response from both OSHA and NIOSH.  There are some
materials in your packet that I'll draw your attention to, but this
takes me back to something Peg mentioned at the very beginning.

		As part of my learning experience as Chair of this committee, I really
feel like it's my responsibility to make sure that we've done some up
front work so that you're provided with materials well in advance of the
meeting.  So I bring your attention to some documents that are in your
packet that you did not receive earlier, but it is a personal intention
of mine to do some more work with the agencies well in advance of the
meetings so that you have materials and prepare yourself for the meeting
better.  And you can hold me accountable for that.

		One of the items that is in the packet is a letter that I received
from John Howard in response to the recommendations that we'd made at
our last meeting.  And I apologize to the committee for having let that
fall through the cracks, and I did not get that out to you in advance of
the meeting.  We'll have a chance to discuss it here, but it's one of
those things that I intend to clean up in the future.

		But with that, let me turn the meeting over to both Debbie Berkowitz
and John Howard.  I'm not sure which one of you would like to speak
first.  You've been on the agenda for a while, so you can take a rest. 
So Debbie.

		MS. BERKOWITZ:  So I'm going to give an update of where we are on the
oil spill and answer questions.  And then Dr. Michaels will be back
tomorrow to talk more about this.

		One thing I wanted to say is I know yesterday there was a report that
was sent around by the Center for Progressive Reform that had some
organizational issue recommendations regarding the National Contingency
Plan and the oil spill.  It was sent to us midday and we haven't really
had a chance to completely look at the report.

		It raises issues and recommendations that we're looking at closely. 
And one thing I wanted to say that we noticed right off the bat in the
executive summary and in other places throughout the report that there
were a lot of errors.  And so I thought I would start our presentation
just talking about what the reality was in OSHA and NIOSH in the oil
spill and how it worked for us.

		I'm sorry that the authors of the report didn't talk to OSHA, but
that's what happens.  Our staff actually is meeting today.  We asked
them all together to do a 'lessons learned' and that's where everybody
-- we still have people in the Gulf full-time.  But everybody that isn't
there has been pulled today and that's where Tom Galosi, Cindy Coe, our
regional administrators that were involved, all the area directors are
having a 'lessons learned' that we asked them to do on the oil spill. 
And so we will have that for you in our next meeting.  And maybe, as
Mike said, we can get something out ahead of time so you can read it and
then formulate your questions ahead of time.

		So looking back, I was just telling somebody that the Latino Summit
ended on April 16 and came back.  We had the weekend.  And then on April
20, the Deep Water Horizon break exploded and I never unpacked my car. 
And I just did it yesterday.  I just took the boxes out on the Latino
Summit.  It really engulfed the agency in a way that I was very proud to
work with people that gave up so many nights and weekends to protect
workers who really rallied to a cause and a calling, especially people
in the field and the people in a couple different divisions here at
OSHA, especially the department DITSM, Technology and Emergency
Management.

		It was a pleasure working with NIOSH.  We got very close to the Coast
Guard and EPA and other agencies.  And at the same time we try very hard
to keep everything moving in the agency so that we weren't sacrificing
other workers health and safety.  And I think that was a challenge and
people rose to it.

		The chronology is, as you probably know, on April 20 the Deep Water
Horizon oil rig exploded.  That afternoon or that evening we had a
meeting at OSHA to figure out what this meant for us.  By April 22, we
had already been talking to the White House about OSHA's involvement,
the national response team was activated.

		On April 23, OSHA went to the first White House briefing on what was
happening.  And by April 26, we had sent our first staff into the field
before oil was anywhere near the shore to start talking with BP and the
Coast Guard of how they were going to clear this up, what they were
going to do.  As you know, at that point we thought the oil was headed
to Louisiana and Louisiana has marshes in all its shore land and this
wasn't going to wash up on a rocky shore.  Also, at that point we didn't
realize it was going to continue until the middle of July.

		So we were down there on the week of April 26, and we started talking
with BP right away about the kind of training they would have to give
workers who were sent out.  And BP brought out a lot of 40-hour HAZ
worker trained people from other parts of the country, put them in their
own housing, gave them their own food.  And starting about that week, we
were on every single morning with the governors of the states that were
involved.

		And as you know, Florida later joined us and Texas.  We had a call
every afternoon with local officials.  And there was real push to hire
local workers.  Hire local workers -- the people, the fishermen that was
displaced.  It was very clear that a lot of the fishermen that were
displaced -- and this all happened to us within the first seven days or
eight days of the spill.  There were a lot of Vietnamese fishermen, so
we started engaging right away with BP on the kind of training that
people would have to have.

		The first actions that all the states, that everybody in terms of the
national contingency plan were laying out clean boom to prevent the oil
from coming to the shore, so there would be no oil exposure.  So those
workers did go out with just about an hour of training from BP.  A lot
of those had already been brought in, as I said, from other parts of the
country to start laying out the clean boom.

		And then by I think it was the second week of the spill, BP had come
up with a four-hour training program that we had required that every
single person that was going to at all come into contact with what's
called 'weathered oil,' and that is people who would be connecting with
oil, not at the source, but as it was coming -- if they're running
skimming operations or on the shore would be exposed to.

		BP hired a company to do that training.  Chip Hughes from NIEHS, our
staff all reviewed the training to make sure it went over health and
safety hazards that they would face, what to do.  And then BP started a
process when they did an open call for workers to send them through this
four-hour training program.

		Our compliance staff by May 3 we already had 20 people in the Gulf and
then until really last week or the week and a half we had mostly about
50 people every day assigned solely to workers in the Gulf.  As you
know, we went into compliance assistance mode, which meant that what we
did was we went to every single staging site.  We went to all the
beaches.  We were on the boats and we were doing hazard identification
and demanding abatement.

		Our job was to ensure that BP protect workers.  Our job was to keep
BP's feet to the fire.  Very early on -- really my first memo I remember
to the deputy secretary was about heat and the problem with -- it was
already 90 degrees by the first week in May and we were already having
first people drop from heat exhaustion.  And we started implementing and
people were starting to work long hours.  And so we started demanding
that BP implement a work rest cycle, shade, Gatorade.

		And what we found was the company would implement it at one site and
it wasn't implemented in the other.  And then we'd go to the next site
and said you have to implement this here.  And then we go back and it
wasn't implemented at the first site because they had changed managers. 
At that point, we got very frustrated because that was a bad sign if
this is how BP was going to take workers's safety.  And so Dr. Michaels
connected with Coast Guard because in the end Admiral Allen was then the
head of the spill.

		We wrote him a letter saying we're upset about BP's compliance with
what we're asking.  We signed an MOU with the Coast Guard and what our
jurisdiction was, just making it clear that BP had to implement this
site-wide and BP then implemented this heat stress program site-wide. 
And one of the things I wanted to say here was I look back on the spill,
OSHA does not have a specific heat stress standard.  And what BP ended
up implementing site-wide was the Coast Guard's heat stress regimen.  It
is the Army's heat stress regimen, which is a work/rest cycle, plus
shade, plus Gatorade.

		And I think it's because they implemented that that we had 930 people
get sick from heat stress.  Most of that was first aid.  There were some
that were taken to the hospital, but we would have had so many  more
because it is so hot down there.  And we got a lot of the local --
officials were very upset about this heat/rest regimen because they
thought the cleanup wasn't going to happen fast enough.

		And so there was a lot of pressure on the agency to lift that and say,
no, no, no that's okay.  Let people work.  And instead we went back to
BP and said work at night.  Hire more people.  I mean we're trying to
protect workers and be efficient and effective in the cleanup of the
spill.

		The other thing that I think for us as an agency, as you know, and Dr.
Michaels will talk about this tomorrow, is the chemical exposures for
the workers.  We were very concerned about -- we brought in a lot of our
industrial hygienist and then we brought our health response team down
from Utah and they were also there by the second week in May or the
first week in May.

		And our permissible exposure limits are incredibly old and outdated. 
And right way we worked with the Coast Guard and BP because we are part
of the unified command right from the beginning that we would be looking
at the lowest recommended occupational exposure limit to judge where
BP's compliance and when workers would need respirators and other
protective equipment.  And that is how we stayed the entire spill.

		And in addition, the other thing that was different in this spill that
I think was very helpful and NIOSH was very instrumental is that we
demanded that BP keep a site-wide injury and illness log, including all
first aid cases.  So you know how the injury and illness logs they're
usually for all cases above first aid.  This was for everything because
this is the way we tried to figure out are there clusters of respiratory
hazards.  We looked at that data every single day to just figure out
what are the patterns, what's happening.

		We were in contact with all local health departments.  We had a call
once a week with all of them.  But then again, as you remember, we're on
with local officials every day.  So if they wanted, they could join that
call also.  So we could hear where are the illnesses, what's happening,
what do people need, where are things going?

		In the end, our staff made 4,000 site visits, and that's all the
beaches and on the boats.  We took over 6,000 exposure assessments
ourselves.  We did put all of this up on our website.  We also demanded
that BP put their exposures up on their website.  We reviewed, I think,
8,000 data exposures from BP through the whole entire spill.

		Very early on, it was clear to us that workers needed to be educated,
not with just a four-training program, and so we instituted that BP
would have safety talks every day on the staging areas before people
went out and when people came in from the boats before they went back
out again they would have safety talks, especially about heat stress and
especially about why you need your personal protective equipment.

		People were provided the gloves and the boots and the Tyvek suits.  We
got a lot of complaints from a lot of local residents, and I completely
understand this that they wanted to keep the beaches open and there were
all these workers in Tyvek suits signaling that this is really toxic and
you can't keep the beaches open.  And so we went through a lot of this
as the oil moved from state to state.  First, it was Louisiana then it
was Mississippi, Alabama, and then in Florida.  So there was a lot of
dialogue.  We worked very hard with local officials in educating the
public and why workers needed to be protected.

		And then our staff did a very good job of constantly bringing up to
BP, every day we would get a list of every site that they went to and
every hazard that they found and all the measurements that they took and
where they were going.  And we would review it at night and the next
morning we would talk to them on the phone, and then we would talk at
9:00 with BP, and that's how the days went.  So it was a constant.

		I remember getting a phone call from Frank Myra, who is a professor at
Hunter saying if all workers could be protected like this.  But it was
great.  We did put as much as we could on the web as we had it.  The
first personal protective equipment matrix got on the web at the
beginning of May and that was replaced later in June by a much more
complicated matrix that went over all those different jobs.

		But if you were working on this spill, if you were doing beach cleanup
and land cleanup, OSHA was there.  We knew the protective equipment you
needed and you were educated about it as you started in your staging
areas.

		As you know, the workers at the source were given respirators right
away.  We didn't really have access to the workers at the source where
the oil was coming out.  That is the Coast Guard's jurisdiction and they
continuous monitoring there and they reviewed the data.  We looked at
the data and NIOSH looked at the data.

		In the beginning of June when they started doing a lot of in-situ oil
burning, we sent our industrial hygienist and we sent NIOSH people going
out and doing the burns and we found that if they followed the
administrative procedures that were supposed to be followed and other
processes that they did not have exposure got above the lowest
recommended levels.  Most of them were very low.

		However, we felt especially as we were moving into the summer with the
wind shifting that wind shifted and all of a sudden workers who were out
there doing the control burns that they could get exposed to high levels
of chemicals.  And so we said to BP you have to provide these workers
with respirators.  The Louisiana Shrimpers Association had really --
that's the one group that had expressed a concern about this and wanted
respirators.

		We then worked with them because they didn't realize they'd have to
shave their beards to have respirators, so we adopted other kind
respirators that they could wear.

		The other thing that happened was at the beginning of the spill people
were laying out clean boom.  By the end of June, they were bringing in
boom that was filled with oil and they were getting covered with oil. 
And we demanded right away that BP increase the amount of training
workers get because this is a whole lot more exposure than when we first
started.  So BP came up with an eight-hour training program and they
were just about to start running all the workers.  It's called the
Vessels of Opportunity, which is what they called any boat that they
hired for the spill to run these through the program.

		We were working with the National Institute of Environmental Health
Sciences who was going to help teach this course and of course, so much
of this course was about identifying symptoms and reporting symptoms. 
Anyway, there was some training going on, but then there was a fire. 
They were going to do the training off-site.  It's about a couple miles
offshore where the boats would come in.  They would go through the
eight-hour training.  They would go out.  There was a fire.  They had to
come into the States and then there was a hurricane and then they capped
the oil.

		So not a whole lot of that training, in the end, went on because there
was no more boats.  There was no more skimming.  There was no burning
and the hurricanes and the booms were lost.  However, some of that
training did go on.  Right after all of the weather that went on, BP
scaled down.  So I think when we addressed you last or within a week of
when we addressed you last there were 6,000 boats and 35,000 workers
employed on the spill or 37,000 on the spill.

		Today there are a whole lot less.  The most number I think there were
37,062 boats.  Today BP on their website says there are 3,000 boats and
20,000 workers, but I think that's an old number.  And I think they need
to update it because we have a list of exactly what beaches they're
going to.  Most of what they're doing now is decontamination.  It's
decontamination of all the boats and the booms and that's really what
we're focused on.

		But before I tell you where we are now, I also want to say one thing
about the agency that was very different in this spill than previous
spills.  I mean, one, I think we were very cognizant of all the concerns
that had been raised to us about Exxon oil spill cleanup and also the
disaster of 911.  And I think we integrated a lot of that knowledge into
making sure that we did things differently.

		And the other thing is that right from the beginning we were part of
the Coast Guard and part of the unified command with the Coast Guard at
the lead and never had any real issues in being there at the table and
having worker safety at the table.  That may be a function of our
President.  It may be a function of our personalities, but we were
there.

		One thing we did right from the beginning was an enormous amount of
community outreach.  OSHA brought in what we call our compliance
assistance specialist who really had done a whole lot of work with
employers, especially small employers and what OSHA requirements are.

		And we had them go down into the Gulf, not only to meet with employers
who were affected by this spill and who now were now were going to go
out on boats or now join the cleanup because that was the only job to
have, but also community and faith-based groups who represented workers
who had lost their jobs and were on the spill.

		We must have done between 50 and 75 organizations that we reached out
to.  We gave presentations to many of them.  We joined up with EPA for a
lot of these.  But from the Vietnamese community and Boat People SOS to
the Latino community to Catholic Charities to United Way we have a list
of where people went so that we would hear from the community, that we
were here for workers.  And our message right way was call us.  We have
1-800 number.  We want to hear from you.

		Right away within the third week of the spill we came up with these
brochures that they're not really low literacy, but it's what we had and
so we put it out so people could see what they could be exposed to.  We
did it in three languages, in Vietnamese, Spanish, and English.  I don't
know if you have it in your packets the little cards in Vietnamese,
English, and Spanish that we distributed.

		When we first testified in Congress in May about what we were doing,
we had already distributed like 30,000 copies of our fact sheets, our
little cards, our books.  And we continue throughout to blanket so that
people would know to call us.

		At the very end of the spill, I would say the last three or four weeks
when the spill moved into Florida we encountered an issue that is
something that I think as an agency we need to review and figure out
what needs to be done to prevent this from the next time.  And that is
we had these companies move in.  BP had required that any supervisor on
a boat or supervisor on an onshore cleanup had to had 40 hours of
training.  And I know NIEHS had their trainers come down and train a lot
of the people initially.

		But then what happened is these companies set up shop.  They came from
out-of-state and they would advertise we can give you the 40 hour in
less.  So that was the first thing that happened and some of our
complaint source officers actually sat in on these and just said no, no,
no.  Or they would train a thousand people with one trainer in a
straight 40 hours, 12 hours days.  It didn't add to 40, but three days a
week, so you figure the math.

		And then the other thing that happened was people then would get
training from some where, a company and they would say we're not giving
you your certificate until you get a job.  And then the people would get
a job and then for some reasons those companies were laid off.  BP were
constantly allocating resources.  We don't need you here in this beach. 
We need you here.  So you were hired one day, fired the next and the
workers wouldn't get their certificate after they worked so they could
go to the next company or the next state to get a job.

		And we ended up getting about 60 OSHA complaints during the spill.  I
would say most of them had to do with not getting their certificate in
the end.  That was really the number one complaint that we were getting.
 We got some whistle blower.  We got some heat stress.  We investigated
all of them.

		We did turn over a lot of this aspects of training that were
fraudulent and that they were holding certificates and taking advantage
of people, or they were not providing 40 hours of quality training and
saying that they were and misrepresenting it in what they were then
saying in their certificates to the Department of Labor's IG's office
and also to the different attorney generals in different states.  So
there are ongoing investigations about that.  That happened at the end
and Dr. Michaels put out a statement about it that I think is in your
packet.

		So that's in nutshell the experience.  As I said, we are now
transitioning in the Gulf because things are very different.  A lot of
the staging areas have been closed.  There is no longer beach cleanup on
a lot of the beaches.  It's mostly tar balls and our main concern is all
the decontamination sites and especially with boats and confined space
entry.  And that's been something we've really been over BP on and that
we're focusing on.  And that's were we are today.

		CHAIRMAN SILVERSTEIN:  Let's hold questions until after Dr. Howard
speaks.  Before I forget it, though, I would make one request of you and
that's if the lessons learned discussions you're having right now
produce a document I would like you to provide us with that document as
soon as it's available.  Dr. Howard?

		DR. HOWARD:  I'm not going to repeat a lot of stuff that Debbie said
because certainly we were involved hand and glove with OSHA and we
really appreciate that.  And I want to extend a personal thanks to
Debbie and Frank Hearl from our office who were literally tirelessly on
all the activities that we did in common.

		I just wanted to emphasize a couple of things.  First of all, you know
this wasn't a Stafford Act FEMA event.  And we've done quite a few of
those Stafford Act FEMA events on the land, but this is a very different
kind of thing on the water.  And I wasn't around when the Exxon Valdez,
working in government, although I was there because I did trainer for
the contractor who was contracted to do the trainer/trainer program.

		But still, this is a very different kind of thing and I thought that
even though it was very different it was very new for all of us.  We did
a pretty good job in interacting with the power structure, which
essentially was Coast Guard and not FEMA. We're very used to the FEMA
issue.

		The other point that I would make, and I've made it several times and
some day I'm going to get the OSHA Medal of Freedom for this is that I
really think that the National Recovery Plan, all of the Stafford Act
issues that OSHA can't be handmaiden to FEMA or the Coast Guard in
getting activated and inserting themselves into the process.  They have
to have their own ability to do it.

		So if you look in the National Plan, you look at ES8 and all that,
they're an annex.  Safety and Health is an annex to the larger issues
and that's really not right.  OSHA needs to be able to say we're coming
in.  We activate ourselves.  That's a point I've been making to anyone
who will listen for several years.

		But the other point I wanted to make is from the perspective of HHS we
had a lot of involvement.  The FTA is much involved, still is in whether
it's safe to eat the fish with NOAA.  SAMSHA was our agency on mental
health issues, very involved in community, issues related to mental
health issues.  NIH, International Institute of Environmental Health
Sciences with the worker education training program, obviously will be
involved very soon and now a little more involved in some of the longer
term health issues.

		CDC, the National Center for Environmental Health and others involved
in working with state health departments in the Gulf trying to do
surveillance, I think that the State of Louisiana health department just
did a terrific job in both collecting information as well as putting it
on the website and giving us all a sense of what was going on there.  I
really thought they did just a tremendous job.

		We're thrilled to work with them on the occupational health side. 
Indeed, they're one of our grantees with our state surveillance program,
but they just did a super terrific job.

		From the NIOSH perspective, again, I want to draw attention to
NACOSH's letter from the end of June having to do with the few issues --
the long work hour issues, the assessment of comprehensive resources,
activities that maybe foregone within the two agencies, the third
recommendation about identifying, evaluating, characterizing major
operations that are being conducted in the Gulf, et cetera.

		Those kinds of information helped us as we formulated and went through
this issue.  The first thing that we did is try to do what the
recommendation that you all made is what's really going on there? 
What's the matrix here of what's happening?  And we came up with
basically on the water exposure scenarios and on the land exposure
scenarios.  So we had six of them, three on the water and three on the
land.

		The water ones, as Debbie has mentioned, is the source control folks. 
That work is obviously exposed to crude as it peculated through the
water column as well as subsurface application of disbursement and they
certainly are at the highest exposure.  And we had the folks that were
engaged in burning, as Debbie mentioned.  And then we had the people
that are engaged in not burning, but in booming and skimming on the
water.

		Then on the land we have the vast number of true cleanup workers, if
you will, responders who are doing all of that kind of cleanup.  You
know a very interesting group of folks.  They were not necessarily what
you would call pure worker types.  All of them were just community
people that came down.  Some of them even volunteered actually, weren't
paid by anybody and the parishes.  That happened a lot.  So that's the
bulk of the people that were involved.

		And then, as Debbie mentioned, this cadre of people that are still now
engaged in decontamination.  Not only decontamination of equipment and
boom and boats and all that, but lots of volunteers came to clean the
turtles and the pelicans and all of that wildlife stuff.

		And lastly, where we had most of the motor vehicle accidents and
people getting squished by trucks and all that kind of stuff is in the
waste stream management process where you're bagging all that dirty sand
and stuff and taking it somewhere, to toxic dumps and all that.  Lots of
trucks and lots of motor vehicles issues going on there during that
process.

		So what we did is we did, and are in the process of still publishing,
we published our sixth HHE report on those essential six exposure
scenarios.  And then when we had that matrix and we presented it to the
Institute of Medicine at their 22nd July meeting -- June?  I can't
remember which month it was.  I think it was July in New Orleans.  Then
we used that as our structure as we went forward.  And one of the
greatest achievements I think that this OSHA/NIOSH interaction over this
particular event was our co-branded interim guidance.

		Now everybody always says OSHA and NIOSH should work well together and
all that.  And they should also do more in this and that and the other
thing.  But to do it is not easy because you have two agencies with
different missions, different viewpoints.  We're in the same statute,
that's true.  Different views about the same set of exposures. 
Different opinions about what's more important to emphasize.

		One part of the partnership can't get into some issues like long
hours.  The other part can and make statements about that, co-branded
document.  How do you work all of that out?  That's where I have to
really give credit to Debbie and Frank because in a series -- I mean
every day on the phone going through words and language.  But the end
was, I think,  a real achievement of a co-branded interim guidance for
all the issues that we saw as important for the Deep Water Horizon
response, including the committee's recommendation about long hours of
work.

		And I think that section alone is a real placeholder that we need to
pay attention as important and we need to build on that issue.  Because
I think as we've talked about this morning it's an extremely positive
achievement between OSHA and NIOSH.

		The other thing that we did in addition to producing that guidance on
our side is, as Debbie mentioned, we learned from the World Trade Center
that the first thing that we have to do if there's to be any kind of
followup, and also to help us during response is who's there?  At the
World Trade Center we didn't have a roster of those individuals who were
there.

		It's not anything but basic demographic information, but we began to
roster by running around the Gulf at the beginning trying to find people
who were already out there and then we did it more routinized within the
training centers.  As people came in, then they got rostered.

		So if you look at our website, and believe me, everything that I'm
talking about is on the website.  We have about 52,000 people rostered. 
Now there are lots of people on there.  It's a different list than the
badging list that the Coast Guard kept.  President Obama's name is on
the badging list, for instance.  My name is on the badging list because
we visited there.  So you get a badge, your name gets on the list.  So
there are two lists.  They don't necessarily correlate.  The roster list
is everybody.

		Now that we will have for the future as we go through time and doing
studies.  The HHEs are all there.  The interim reports are there.  We're
going to have a final report that will be one comprehensive, global HHE
report.  We're not there yet because we're still analyzing data.

		As Debbie mentioned, one of the other, I think, significant
achievement is that we made a realtime injury and illness safety log
kind of information.  And that is, we then took it -- and believe me it
was in sorry shape.  And our staff and the Emergency Response
Preparedness Unit spent hours and hours and hours making it into a
legible, readable, utilizable piece of information and those are on our
website.

		Bar none, heat stress was the number one problem and lacerations,
rashes, and getting hit by a vehicle that you're in the wrong place for
and all these vehicles in a very small area.  I explained to a committee
one time that I was testifying in front of when they're obsessed with
the cruel oil.  I said, yes, there's cruel oil exposure, but there's
also 50,000 people out there in a very small area running into each
other.  Those are real hazards, too.  So that entry notice data I think
is another real achievement.

		We also obtained, through a lot of work and effort, and I thank BP for
this.  We obtained samples of the disbursements, 50-gallon samples of
the disbursement.  And we also obtained unadulterated, meaning
non-disbursement contaminated crude oil from the Macondo well.  So we
are doing animal toxicity studies now as a first step to look at acute
toxicity of crude and disbursement.

		This is a very unusual crude.  It's not the same kind of crude that
exist all over the world.  There's a very, very absent kind of sulfur
content to this crude.  It's a very different kind of crude.  The
disbursement are the big issue and they will continue to be the big
issue.

		I think primarily because if you're going to put a million pounds of
them, even though the workplace that you're talking about is a 600,000
square mile body of water, nevertheless, a million pounds of a chemical
in close proximity either in three ways -- through subsurface
application or the airplanes, which I testified several times please
stop spraying this by an airplane because there are people underneath. 
And then on the vessels with little sprayers over the side and they
would go through the surface.

		So whatever way I think that will be continuing to be the toxicity
issue that will follow because there's a couple issues with regard to
that.  Not only did the event happen, but what are the implications for
the use of that large amount of disbursement in future tanker spills or
oil spills?  Have we now established that's going to be pattern and
practice?

		We have to establish whether or not that's a helpful pattern and
practice if that's going to be the way that you break up oil and take
care of oil spills.  So I think that's going to be the number one health
issue as we go through.  And the second big health issue will be the
community behavioral stress issues due to social disruption, economic
disruption, all of that within the community.  I think that would be the
next big thing.

		So in terms of where we're going now, there will be an Institute of
Medicine meeting on the 22nd of September in Tampa, Florida.  The
Institute of Medicine has a panel of health experts that will be looking
at whether or not longer term studies are warranted, what kind of
studies should be done.  One example of a study is the National
Institute of Health have a 91-page protocol on the ION website that you
may want to look at trying to look at perhaps a longitudinal, a large
longitudinal cohort of folks that were exposed in this response.

		So I just wanted to also point out that the committee, in addition to
their long hours recommendation, which we incorporated into the interim
guidance, made the second recommendation about having OSHA and NIOSH
prepare a comprehensive assessment of resources.

		What we did there from our perspective is that what we did is say,
look, we're sending a lot of people down there for travel and hotel.  We
billed the Coast Guard for that and the Coast Guard gave us an account
for that.  What we did not do is that we used our own funds to do all of
our HHE analysis because we didn't want our HHE results to -- anyone to
say that they were compromised by funding from outside of NIOSH.

		We continue to that with animal toxicity studies.  We will only pay
for that by ourselves and we look forward to those studies.  I'm happy
to report about those as we go through time.

		CHAIRMAN SILVERSTEIN:  Thank you.  Questions for either OSHA or NIOSH?

		MR. BUCHAN:  This is a learning experience for me.

		DR. HOWARD:  For all of us.

		MR. BUCHAN:  I've heard a lot about the disbursements, but I don't
know what they are chemically and what the toxicology is.

		DR. HOWARD:  They're more hydrocarbons.  And the point that I made
don't we have enough hydrocarbons in the Gulf already.  But they're
hydrocarbons that are essentially like a surfactant type of chemical. 
The problem is there were two major types.  One was used for only a very
short period of time in may called 95/27, or corrective 95/27
manufactured by the Nalco Corporation, which we have to thank for
getting us the samples of the disbursement to study through an agreement
that we have with them.

		97/25A has a hemolytic agent in it, which can cause blood dysplasia,
hemolytic issues with kidney problems and all this and that.  Then they
switched.  The EPA said no, no, no.  We don't like that.  There was a
very short use there, so we don't  know really how much exposure
actually happened here with that.

		But the larger amount is 95/00A, okay, which does not have as high a
concentration of the butoxyethyl as the 95/27.  It resembles as has been
said by a number of folks more your dishwater detergent as opposed this
high concentration of butoxyethyl.

		MR. BUCHAN:

		CHAIRMAN SILVERSTEIN:  Bill?

		MR. BORWEGEN:  Is this related to the -- any related to the chemicals
EPA just decided to ban in industrial laundry detergents as of a week or
two ago?

		DR. HOWARD:  That I don't know.  I'm not 100 percent sure of.

		CHAIRMAN SILVERSTEIN:  Peg?

		MS. SEMINARIO:  Thank you very much for comprehensive presentations
and for all the terrific work that both agencies did.  I mean I think
it's clear that both OSHA and NIOSH got themselves quickly organized and
activated to be fully engaged in these response activities.

		But I think one of the things that's worth noting here, and it's
similar to what has happened in 911.  It's similar to what happened
after Exxon Valdez, Anthrax that when we have these incidents, and this
was again a different kind of major incident, that all of it is learning
as we go and we need to get beyond that.  And the work that was done
here I think not only your internal lessons learned, but I think laying
out some templates for what needs to happen in the future is really
important.

		And the point that you made, John, at the beginning is that when you
look at the role of occupational safety and health in OSHA, in
particular, in all the formal planning activities and authorities,
whether it's under the Coast Guard in oil spills or the Stafford Act and
instituting national response activities there, worker safety and health
is a side issue.

		DR. HOWARD:  An annex.

		MS. SEMINARIO:  And an annex.  And I think one of the things that
would be important here in the lessons learned is that it does need to
be front and center and integrated and have the plan up front.

		In my recollection also in terms of dealing with the annex, at least
under the Stafford Act is that part of what happens there in the annex
activities is looking at the health and safety of the federal resources,
but not necessarily the private resources.  And here the issue was
mainly the workers who were responding and then also the citizens in the
Gulf.  So I think that's one of the things that we should really think
about and look at here as to how does the work that was done here then
become basically institutionalized in some way so that the next time
this happens, and there will be a next time.  We don't know where it
will be.  Will it be on land or sea, and what the exposure will be? 
That there is a better system in place to begin with that can be
followed and so that every step of the way you're not trying to just
figure out this piece, that piece.

		And in this regard, I know from the activity that we were involved
with a lot of the success is -- Debbie said something about
personalities here.  It really was the strength that Dr. Michaels and
Debbie and Dr. Howard and others brought to this in insisting that the
worker safety issues be there.  But if you look at the plan on paper,
that wasn't necessarily the case.

		And we won't always have a David Michaels or a Debbie Berkowitz or a
Dr. Howard.  And so we shouldn't just be relying on the fortuitous
situation that we've got the strong people there who believe, but that
it's got to be built into the systems.  And that has not really taken --
and that's the one thing we take away from this that I think perhaps is
important as we look forward on this.

		And in doing the lessons learned, I think to be clear about what would
have been helpful to the agencies in terms of both authorities,
resources, et cetera to be able to do your job in a more effective way.

		CHAIRMAN SILVERSTEIN:  Debbie?

		MS. BERKOWITZ:  I just wanted to say that at the beginning, Mike, you
talked about issues where the agency could use NACOSH's involvement and
I think this would be a great one about the planning and what should we
do so we're ready for the next one.  I mean this wasn't the Stafford
Act.  This was very different.  This was the National Contingency -- it
was a very different vehicle.  And right from the beginning we were
there.  We were part of it.  And that may or may not be what was on
paper, but we weren't pigeon-holed to having to follow certain things on
paper.

		We did, as John said, we all are getting reimbursed from BP for our
field staff, but our national staff is not and we're all keeping track
of our hours so we can look back and just see, yes, we all did work
24-hour days.  But I think it would be very helpful if this is something
that NACOSH could take a look at and we're happy to work with you.

		CHAIRMAN SILVERSTEIN:  We do have time scheduled for workgroups later
and we do have one workgroup already in place, specifically on this
issue and I think it certainly ought to be taken up during that
conversation later.

		Are there other comments or responses to this issue that was just
brought up?

		(No response.)

		CHAIRMAN SILVERSTEIN:  We'll deal with that in the working group later
today.  We will not let that one drop.

		Other thoughts, questions, comments on Gulf Oil issues?

		MS. SEMINARIO:  I have just a question of a follow up of a specific
question here.

		You talked about the major work going on right now is decontamination
and also the fact that those are the folks that needed more training,
like the eight-hour training I think you said.

		MS. BERKOWITZ:  No, they didn't --

		MS. SEMINARIO:  Because there's more exposure in terms of what they're
dealing with as far as contaminated booms, boats, whatever.  And so what
kind of training are these people who are involved in this having,
because obviously their exposure is more than dealing with the tar balls
on the beach.  And what level of resources is the agency now devoting to
the follow up with the work that remains?

		DR. HOWARD:  On the exposure issue for decontamination workers, we
have an HHE on that issue.  We were concerned earlier on.  I think
Debbie mentioned this is not Exxon Valdez where we had that ridiculous
power washing of the rocks like you were Ms. Manners trying to clean up
the Laura Ashley showroom after an oil spill or something.

		First of all, we knew that it was a marsh.  There were no rocks that
they'd want to pressure wash. But then we thought if they're
decontaminating all this stuff and they're going to be using hoses and
all that kind of stuff we were concerned about that.  So we did an HHE
about that issue.

		Now I don't know how it got translated then in terms of the training
those particular individuals have.  That I don't know because we weren't
so much involved on the training side.  But we were very concerned about
exposure and being able to figure out what was going on in that area.

		MS. BERKOWITZ:  We are monitoring the decontamination sites because
that's one of the areas where we'd let BP know workers may need
respirators and they should have them.  And as I read most of the site
reports, so far the exposures have not been high enough to trigger any
of that.

		And in terms of the training, it's not completely true that they have
higher exposures.  I mean the people that were going to get the
eight-hour were the workers who were on the vessels of opportunity who
were handling bringing in the contaminated boom, not decontaminating. 
They were actually getting it out of the water and getting soaked with
weather oil.  And some of them were fairly close to the source.

		So I can get back to you on -- I actually have all that.  My staff are
not here.  They're all in the 'lessons learned.'

		MS. SEMINARIO:  Right.

		MS. BERKOWITZ:  The exposures that we're really concerned about are
not so much with the weathered oil, breathing it in, but is with dying
in a confined space and just making sure people have their protective
equipment.  And we're constantly monitoring some situations.  As they
set up new areas, we go right in there.

		One thing we've also been in a lot is there's still a lot of wildlife
rescue going on.  And some of this are volunteers and some not.  All of
those people have very extensive training.  They've all had to get 24 or
40 hours.  And we have gone in and done site visits there just to
measure exposure levels and do spot checks of where people are.  And so
we're still keeping our eyes on them because there are still quite a
number of them.  And in terms of the beach cleanup, it's just mostly
removing the tar balls now.

		CHAIRMAN SILVERSTEIN:  Joe, you had your hand up?

		MR. VAN HOUTEN:  It's still a nagging question that I never got an
answer to.  Who has jurisdiction over this whole incident, like who's
investigating the initial deaths of the workers and the follow up to the
explosion?

		DR. HOWARD:  Those are two different questions.  One, who is in charge
is the Department of Homeland Security, Secretary Napolitano.  And then
she appointed the incident commander, Thad Allen.  The Coast Guard is
part of the Department of Homeland Security.  So for purposes of this
type of on-the-water response, they're in charge.

		MR. VAN HOUTEN:  I'm looking at the grander incident, so who's
investigating the explosion that killed the 11 workers?

		DR. HOWARD:  There are a whole bunch of people that are investigating
that.  There's a panel.  The President appointed a panel.

		MS. BERKOWITZ:  Right.  And BP just came out with their analysis,
which was in the -- so BP did there own investigation.  But there are
many federal government investigations in addition.

		MR. VAN HOUTEN:  OSHA does not have jurisdiction?

		MS. BERKOWITZ:  No.

		DR. HOWARD:  No.  It's 3 miles.  That's the end of the line.  But it's
interesting because in this whole process, during this we had a
reorganization of the Minerals Management agency, which has some
jurisdiction.  The Coast Guard has some jurisdiction.  There was a
hearing in front of Energy and Commerce that Dr. Michaels and I
participated in with the new BOMA, the Bureau of Oceans.  I forget their
new name.  They're not Minerals Management any more.  And the Cost Guard
was there.  It was very hard for me to follow who had jurisdiction over
what particular activity on those offshore platforms.  It's a whole area
that I'm not capable of explaining.  But you could read the transcript
from that hearing and try to figure it out.

		MR. VAN HOUTEN:  That's not what this group could talk about?

		CHAIRMAN SILVERSTEIN:  Perhaps.  And I think when we're really
exploring what areas we want to dig into I think we ought to think more
about this one.

		MS. BERKOWITZ:  Let me just add to this and say that even though we
are a small agency our jurisdiction -- we went out on boats that were up
to the source.  So where the source was, where the oil was coming out of
the ground that's Coast Guard and MMS.  MMS are the people on the rigs
and the Coast Guard also.  But  are jurisdiction, technically, is just 3
miles out on shore and then after that we don't have jurisdiction.  But
because we had the expertise on worker safety, we went out on boats
right up to where the source was.

		MR. VAN HOUTEN:  Let me put this in a somewhat bigger context because
I think there is a bigger issue here.  If you look at the oil and gas
industry as a whole, we have seen in the last year major safety and
health problems as well as environmental problems all the way through
from extraction, Deep Water Horizon is an example, through refining
where you've got the Tesoro Anacortes disaster as well as a number of
others, BP not the least of which and distribution.

		I mean just last week we had the horrible explosion that almost blow
up the entire city of San Bruno.  And I'm thinking each case trying to
figure out who has jurisdiction and who is actually in charge and how
these issues are managed.  It's a maze that nobody really seems to be
able to work through in a coherent way and I think it's a major national
issue that goes well beyond what this committee can do.  But there may
be some pieces of this that we can look into effectively and provide
some advice on.

		MS. BERKOWITZ:  And one area that we're looking at that is something
for you to think about is we are really trying to leverage our resources
like we did with NIOSH to work together with other agencies who have
different pieces of jurisdiction.  So we're sharing information and
going back and for.  So as soon as the new head of the new MMS was
appointed, now called BOMA, Michael Boehmer.  We've met with him many
times.  We've gone back and forth to educate them on what we know about
process safety.  Anyway, so it's something for you to think about in
terms of recommending to us.

		MR. VAN HOUTEN:  One point that I was reflecting on is that you did a
great job with this spill cleanup.  I'm very impressed with the work
that OSHA and NIOSH did here.  It would be a shame if we couldn't take
advantage of the expertise that your agency has to help prevent the next
explosion on an oil platform.  That's what I'm interested in trying to
bring that expertise into the overall scheme.

		CHAIRMAN SILVERSTEIN:  Linda?

		MS. MURRAY:  I have one question, but let me say something about this
chaos.  Every emergency is chaotic, otherwise almost by definition it
wouldn't be an emergency.  And even H1N1, which we should know how to
deal with the flu.  It happens every year.

		With all due respect to our attorneys, it's was more than frustrating
these legal, strange notions of who has jurisdiction.  I'm glad you all
ignored that as much as you could and encourage you to do it more.

		But my question has to do with the interaction between OSHA and NIOSH
and state and local health officials.  And as you answer that, the
reason I ask the question is this to me seems to be, especially for
NIOSH a strategic issue.  We're unlikely to have in anyone's lifetime in
this room the number of health and safety professionals that we need, in
general, and certainly to respond to emergencies.

		And so a strategic notion which fits in, which ought to fit in with
the motion of CDC is how do we build local and state infrastructure in
capacity in these areas?  And so I'm interested in what happened to the
public sector workers that were there, whether they were public health
or other local or state health -- governmental workers because I know
they were there on the ground.  What's the responsibility for helping
them, making sure they had the protection and training that they needed
and giving them some capacity because one of their tasks to help protect
workers and the general public.  So I'm interested in that.

		But again, for that to be a major strategic initiative of NIOSH and
OSHA, but especially NIOSH seems to me to be critical if we're going to
be able to go forward with this.

		CHAIRMAN SILVERSTEIN:  Let me ask one follow-up question.

		John, you indicated that you thought that heat stress was the leading
specific safety and health problem that emerged during this.  And
Debbie, you noted that OSHA does not have a heat stress rule and that
you had to rely on guidelines from the Army.  Where do you think we
ought to be moving with that gap? Is that something that needs to be
closed or did that actually get worked out on the ground in practice
adequately.

		DR. HOWARD:  For us, we're very interested in incorporating that piece
in two different ways.  For responses that involve heat exposure, we
would certainly like to take the lessons learned from this exposure and
incorporate that into a general template that Peg has talked about.

		And in fact, we have interagency group that has been meeting for about
a year, a year and a half.  They're ending their activities.  We will
have a model program, if you will, that we will incorporate that
particular lesson.  And then I think the issue that I would propose and
I think Dr. Michaels is interested in is to take the heat stress lessons
that we've learned from this response and then perhaps develop a set of
publication on that issue for that NIOSH and OSHA could co-grant on heat
stress in response to activity as well as in other things.

		For NIOSH it's been quite a few years.  There was a document done in
the eighties, which we relied on in California to do the heat stress
standard there that was a NIOSH document.  But we need to probably look
at how we can update our own publications in that area.

		CHAIRMAN SILVERSTEIN:  Yes, I'll look forward to seeing where you go
with that.

		Peter Dooley?

		MR. DOOLEY:  Yes, Peter Dooley.

		Just one comment in terms of lessons learned through this whole
process.  I mean one of the big controversies that was happening from
the beginning of the spill was this issue of health affects for workers
and some community members and the level of protective equipment that
might be best used in different work situations and the way in which you
determine that in terms of air sampling and trying to figure out what
chemicals were involved and what's being used.

		And I hope that we can learn some lessons that might help us to be
protecting workers and community members in a more efficient way from
the beginning and using the best available technology for protective
equipment in various work situations.  So the whole control banning
model of we have certain jobs that are done and we know that there can
be certain protective measures that are used for those jobs instead of
thinking that air sampling is going to be the best way to rely on
determining what should be used.

		Because we all know that air sampling can be very, very difficult to
access the exposures.  And of course, the limits that we use are very
outdated and such.  So that might just be one area that we really look
at to try and learn a lesson from this.

		CHAIRMAN SILVERSTEIN:  We clearly haven't exhausted this area, but we
do have a work group that will be meeting later.

		I've got to admit that coming into the meeting this morning it wasn't
at all clear to me whether or not the workgroup we had established maybe
had already outlived it usefulness.  That clearly is not true.  I think
some very important follow-up items related to lessons learned have come
up that that workgroup can continue to work on fruitfully.  So we'll
come back to that, or at least the workgroup will and then the whole
group tomorrow.

		So I want to thank both of you for providing the information and
helping us to figure out where to go next.  But Debbie, it looks like
you wanted to say one final thing here?

		MS. JONES:  I just wanted to say one thing.  This is Tina Jones who is
with Department of Technical Assistance and Emergency Management.  And
if you haven't been on our website, and I think most of you haven't, but
we did put up 17 different job -- this is what NACOSH asked us to do,
the different jobs where protective equipment was required and put
pictures up.  We did get copies out to the field so people could be able
to see it.  I don't know.  Did a great job.  I mean we went up with our
website I think in five or six days right after the spill.  Anyway, I
just think she did a great job.

		(Laughter.)

		CHAIRMAN SILVERSTEIN:  Thank you.  So we're going to move on to the
last item for the morning, which is additional updates from OSHA on some
areas of importance to the agency.  And then I think Dr. Howard is going
to be back later to talk about influenza.

		MS. BERKOWITZ:  Mr. Chair, at this time I'd like to take care of quite
a few housekeeping items.  These are going to be exhibits added to the
record.

		As Exhibit .5, the June 30, 2010 letter from NACOSH Chair Michael
Silverstein to Dr. Michaels on NACOSH recommendations regarding the Gulf
Oil spill of 2010.  As Exhibit .6, Dr. Michaels's July 19, 2010 response
letter, .7 a list of OSHA reference materials provided to NACOSH on
keeping workers safe during the oil spill response and cleanup
operations.  As Exhibit .8, a fact sheet on OSHA's efforts to protect
workers during the oil spill response and cleanup operations.

		As Exhibit .9, OSHA current training requirement for the Gulf Oil
spill dated July 21, 2010.  As Exhibit .10, the NIOSH/OSHA interim
guidance for protecting Deep Water Horizon response workers and
volunteers dated July 26, 210.  As Exhibit .11, an update of OSHA
activities to protect oil spill workers in the Gulf dated August 31,
2010.  As Exhibit .12, Dewell's August 18, 2010 statement warning
employees along the Gulf against withholding of HAZWOPER certificates.

		As Exhibit .13, OSHA's emergency response to oil spill initial
sampling strategy dated August 4, 2010.  As Exhibit .14, OSHA direct
reading results on the Gulf Oil spill as of August 4, 2010.  As Exhibit
.15, data on BP sampling on 2-B Toxic Ethyl.  As Exhibit .16, OSHA's
fact sheet on handling snare booms on the shore dated August 23, 2010. 
As Exhibit .17, OSHA fact sheet on skimming operations near a shore
dated August 23, 2010.

		As Exhibit .18, a document entitled Safety and Health Awareness for
All Oil Spill Cleanup Workers, June 2010 publication in English.  As
Exhibit .19, that same publication dated 2010 in Spanish.  As Exhibit
.20, a contact OSHA card in English.  As Exhibit .21, a contact OSHA
card in Spanish.  And Exhibit .22, the contact OSHA card in Vietnamese.

		CHAIRMAN SILVERSTEIN:  Thank you.

		Let me just do a little check in here with the group.  We do not have
a break scheduled now.  The agency calls for an hour that will take us
through 12:30 which cuts into the usual lunch hour.  We can handle
things in a couple different ways.   We can just proceed with the agenda
as it is, just no break and continue for an hour.

		We could take a quick stretch break now and then do our hour, or we
could, and this would, in part, depend on the OSHA staff.  We could do a
half an hour, take a break for lunch and come back and do the other half
hour after lunch. Several different options.

		MR. BUCHAN:  I think 10 minutes right now and then go for it so that
we can all go to the restroom or whatever.

		DR. HOWARD:  Yes, I don't think we should split the OSHA presentation
in two.

		CHAIRMAN SILVERSTEIN:  That's fine.  Let's do it 5 minutes.  Okay,
5-minute stretch break and then we'll go through the whole --

		(Whereupon, a short recess was taken.)

		CHAIRMAN SILVERSTEIN:  We're going to move onto the next subject,
which is an update from OSHA on a variety of issues that may give
interest.  I'm sure will be of interest to the committee, but some of
which maybe subjects that we're going to take up in more detail.

		So, Debbie, how would you like to proceed?  Some introductions first?

		MS. SEMINARIO:  Do you want me to do them?

		CHAIRMAN SILVERSTEIN:  Yes.  If the three of you would introduce
yourselves.

		MS. SEMINARIO:   We have a panel.  I just want to tell you that
Dorothy Doroghty, who's the head of our Department of Standards of
Guidance is out sick today and we have her incredible staff here with us
to help with some updates.  Because Tom Glossie who is our head of our
enforcement is down at our 'Lessons Learned' I'm going to fill you in on
some updates at the beginning, mostly on enforcement and a couple of
other initiatives that Dr. Michaels will also talk about tomorrow.

		But we also have Mike Seymour from Department of Standards and
Guidance, who's going to give you a briefing on injury and illness
programs and where we are.  And Mandy Edens is going to talk about our
work on PELs, but also can talk to you about any other questions you
have on our standard and guidance activities.

		So I thought I would provide an update on a couple of things that were
raised in the last meeting and also to just give you a sense, if you
haven't been following our website and our 4,000 press releases.  We're
trying to hen we do things announce it in a way that our stakeholders as
well as the media can see because the media often doesn't cover health
and safety issue, but we think that you want to know and would be
interested.

		This is an update since we last met.  And one thing I thought I'd give
you an update on, a program that we just initiated is our Severe
Violators Enforcement Program and I'm just going to talk about some
enforcement issues.  And that was initiated about a month ago and it is
replacement of another program, EE, Enhanced Enforcement Program where
there was a congressional hearing over a year ago on that program and
there were some serious flaws.

		So the Severe Violators Enforcement Program actually takes into
account the flaws in that program that were pointed out by Congress. 
And it is our program where we are focusing on the more recalcitrant
employers, which is where I think we should be focusing our resources is
on the most dangerous workplaces.

		And the SPEC Program is the nickname targets employers in a couple of
different categories that have willful repeat or failure to abate
violations when there's a fatality or catastrophe situation, when
they're exposing workers to occupational hazards that are subject for a
national emphasis program or are a high hazardous emphasis program or
that are exposing workers to hazards related to potential release of
highly hazardous chemicals or are involved in an egregious case.

		The program which is a little over a month or so old we have 27
companies in the program already.  We are going to go up with a website
to explain to people what this program is and we will list the companies
who are part of this program.

		The SPEC is a supplemental enforcement tool that includes increased
OSHA inspections in these work sites, including mandatory OSHA follow-up
inspections and inspections of other work sites of the same employer
where similar hazards and deficiencies may be present.

		And I have a breakdown of some of the initial cases that are in there
I thought you may want to discuss and that is that 23 of 27 of the
companies have 100 or less employees.  Four are larger than 100. 
Twenty-four of the 27 cases are in construction.  And 3 of those 24 in
construction were brought in because of fatalities.  The rest is because
of hazards related to a national emphasis program we had or other high
hazard.  So that program is underway.

		I wanted to give you some other updates on enforcement and that is as
we approach the end of the fiscal year on October 1 we will have 18
egregious cases this year, which are the cases again against employers
that are the most recalcitrant employers that have willful violations. 
Last fiscal year there were four cases.

		And one other thing in terms of an update we have a national emphasis
program on recordkeeping that's continuing through this fiscal year.  We
have around 185 inspections that have been initiated under it.  We are
slightly adjusting the targeting mechanism in that national emphasis
program and that should be done within the week.  So we're still moving
forward on that.

		I also wanted to talk in terms of enforcement of things that have
happened since we last met to get your feedback.  And that is, if you go
to our website, and we'd love feedback on our website, by the way
because you all represent various stakeholders and how people are using
it and how navigatible you think it is.  And we're trying very hard in
terms of improving it and getting everything out on the website in the
spirit of being open and transparent.

		But there were a number of deaths in grain elevator solos.  And a
number of completely preventable deaths in very high profile cases that
got a lot of media attention.  We actually issued three of our egregious
cases just in the last nine months to the grain industry.

		In the early 1980s or the mid-1980s, OSHA passed a very specific
standard that not only addressed how to prevent explosions in a grain
facility, but also how to prevent people from dying in grain bins and
confined space.  It's a standard with very specific, common sense rules
that if followed you won't get killed and people are just not following
it.  They're just decided not to follow it.  That somehow this isn't
going to happen to them.  And there have been so many deaths.  Last year
saw the highest number of deaths in entrapments in grain elevators from
the universities and various other academic institutions that we've been
in connection with that keep track of these.

		In November, we put a press release out calling on grain elevator
operators to prevent these deaths.  That's there a standard and to try
to alert them.  And I don't think anything happened with that.  So this
time when we had just issued a big citation for a company in Wisconsin
and then one week later a 14-year old and a 19-year old were killed in a
grain bin.  We issued an open letter to grain storage facility
operators.

		The national office mailed it to -- our list is actually on our
website, I think around 2,000 grain storage facilities.  And then we
asked the states to mail it to grain storage facilities.  The states
that have their own state OSHA to just get the word out.  We started
partnering with different journals and publications in the grain
industry, universities to figure out how do you get the word to
companies that there is a standard.  There are practices, just follow
them.  So that I think Deborah has distributed to you.

		In addition, the Clean Energy Explosion case we issued those citations
in August.  And that case, again, was very preventable and we felt very
strongly that the practice of cleaning fuel gas piping systems with
natural gas was incredibly dangerous, that people know how to prevent
it.  That there's substitutes available.  And again, we issued a letter
to I think 165 companies who would be building or refurbishing a power
plant who would be involved in this kind of activity to alert them to
the standards that we have out, to the general duty clause.

		Again, this was a case where it was a preventable incident.  They were
welding while they were doing the purging of the gas system.  So it's
just another tool where we're trying to communicate with employers and
workers about preventing unnecessary deaths and illnesses and hoping
that these letters in some way help us in our mission in terms of
deterrents because our job really is, as Dr. Michaels said, is leveling
the playing field so that employers that don't cut corners and make
investments in health and safety aren't undercut by those that do, often
just for short-term gain.  And then there's a real cost to this in terms
of disease, injury, and death.

		And the last thing I wanted to alert you to because this will be
happening next week.  And that is OSHA is launching an initiative
distracted driving.  The BLS statistics, the preliminary statistics just
came out.  And as you know, motor vehicle incidents are one of the
leading causes of occupational fatalities, especially on the road.  The
motor vehicle crashes and killed a lot of workers.

		The data is that between 11 and 20 percent of all car accidents are
due to distracted driving, that we are joining forces with Secretary
LaHood of the Department of Transportation, who's really taking the lead
on this issue.  And our focus is going to be on preventing texting while
drive.

		The Secretary of Labor will be making a speech announcing our
initiatives next week at Secretary LaHood's distracted driving summit
here in Washington, D.C.  We can talk more about that, but it's the
first OSHA has really gotten involved this way.  And it's a
multi-pronged approach and we're working across different government
agencies and looking to partner with other organizations and nonprofits
and employer groups to see if we can make a difference.  That's my
report.

		CHAIRMAN SILVERSTEIN:  Thank you.

		Why don't we go on and hear from all three and then do questions?  Is
that okay, Emory?

		MR. KNOWLES:  Sure.

		THE COURT:  Mike, you want to go ahead?

		MR. SEYMOUR:  Yes.  Good afternoon.  I'm Mike Seymour.  I work under
the Director of Standards and Guidance and I'm the project lead on our
Injury and Illness Prevention Project.  I thought I'd give you a very
quick update on what we've been up to and what we've learned and where
we think we're going next on this important project.

		As I know most of you are aware, this is perhaps Dr. Michaels's number
one priority project.  This is something he believes in very, very
strongly and has encouraged us to move forward smartly, if you will.

		But let me talk a little bit about what we're thinking about with
respect to our Injury and Illness Prevention Program regulations. 
Staying consistent with OSHA's history on safety and health programs, we
have taken an approach of using core elements as the major organizing
focus in our drafting of the rule.  So certainly, one key core element
is management, what has been called management commitment.  We would
tend to call it management duties in a regulatory sense.

		And in that we're thinking about requiring that employers establish
safety and health policies.  That they set goals for their programs. 
That they plan and allocate resources.  Certainly, that's a key
subelement, and assigning and communicating roles and responsibilities
to make sure that there's an organizing for in injury and illness
prevention programs.

		We feel very strongly that employer participation is a core element. 
Currently, under our guidelines the employer participation is kind of
subsumed in the management commitment core element and we think it's
important that that borne out as a stand-alone element as making sure
that employers are responsible for gathering the wisdom from their
employees, giving employees a voice in safety and health programs.

		Certainly, employer participation is important in all of the
implementation of our program, from establishing the program to
maintaining and evaluating the program, making sure that employees get
access to safety and health information so that they can be as effective
as they can be in providing their input.  And making sure that employees
have a key role in incident investigations.

		The third core element is hazard identification and assessment. 
Clearly, that is one of the major points of this.  This is what we've
termed a find and fixed rule, and this is the find part.  And so we're
trying to develop language that addresses what hazards must be
identified.  We want to make sure that employers gather the appropriate
information so they can identify their hazards.

		We want employers to conduct thorough workplace inspections.  We want
them to conduct incident investigations, not only for those incidents
that end up in an injury or worse, but also for those near misses.  Some
people at our stakeholder meetings called them near hits, which I
thought was really quite appropriate.

		Also, we want to focus people on hazards associated with changes in
the workplace, focus on emergency.  And part of the identification
process is also a prioritization.  We want them to understand which of
their hazards should be a high priority for control and which hazards
they might be able to wait a while to control.

		One of the things that we're very keen on making sure that we do in
this process is to develop some hazard identification tools.  Certainly,
the small and medium businesses that we've heard of in our stakeholder
conversations feel that they don't have the tools they need to
adequately identify their hazards.  And we intend to give them some of
the tools they need to move forward and do that in a competent way.

		Certainly, hazard prevention is the other part of the find and fix. 
And in that we're talking about what hazards need to be controlled and
certainly hazard control priorities and some way of tracking the
effectiveness of controls is important for us to consider in a future
rule.

		Certainly, training and education is important and we're talking about
requirements for specific content and for the frequency of training. 
Focusing here not only on the training of workers, which is absolutely
key, but also training of the people that have responsibilities for
implementing and maintaining and managing the Injury and Illness
Prevention Program so that they're competent to do that.  So it's really
a two-tiered training and education issue.

		And finally, program evaluation.  No program works well unless you
know what you're trying to accomplish and then check up and find out
whether or not you did, indeed, accomplish it.  So program evaluation
for the Injury and Illness Prevention Program is a real key element.

		To give you a feel for where we are, we just finished a stakeholder
meeting process.  We conducted five stakeholder meetings.  They were
attended by on the average 40 people participated in each the meetings
and we had something in the neighborhood of 150 or so people in the
audience for each of these, so they were very well attended.  They were
lively conversations.  We had lots of good ideas.

		We held the first one in East Brunswick, New Jersey at the beginning
of June; Dallas, Texas in the second week in June; here in Washington
toward the end of June, again, another one in Washington, we had plenty
of people who wanted to participate in that meeting.  Enough to have a
full second meeting, which we held on July 20.  And the final meeting we
held out in Sacramento, California on August 3.

		The notes for all of these meetings are on our website.  I believe the
Sacramento meeting, the notes for that meeting will go up this week or
at the latest early next week.  We're just in the process of finalizing
those notes.  But there you'll find 15 or 20 pages, very detailed notes
of the commentary and the conversations that took place those days.

		The meetings were eight hours long.  They went from 8:00 or 8:30 in
the morning and they adjourned at around 4:30.  And they were very
lively and they were very good conversations.  We learned quite a bit.

		MR. BUCHAN:  What were the composition of people?

		MR. SEYMOUR:  I'm sorry?

		MR. BUCHAN:  What was the composition of people?  Were there small
business employers?

		MR. SEYMOUR:  There were small business employers.  Trade associations
were certainly prevalent here at the Washington meetings.  The labor
unions were in attendance in all of the meetings.  So I think we got a
very good spread of perspectives on how to move forward and perspectives
on this important subject matter.

		MR. BUCHAN:  Thank you.

		MR. SEYMOUR:  Given that we had almost 40 hours worth of meetings, I
really can't give you a good synopsis of everything that was said.  But
let me give a couple of snippets of the kinds of things that we heard.

		We heard the I2P2 standard or the Injury and Illness Prevention
Program standards should be flexible, yet enforceable.  We heard that
standards should be simply, yet detailed.  We heard that safety
committees are effective, yet may run afoul of the National Labor
Relations Act.  We heard that management systems are desirable and yet
small businesses may not implement them.

		We heard write a performance standard, and yet tell all employers and
compliance officers exactly what's required.  And we were told that
everyone should have a written program, yet written programs tend to sit
on the shelf.

		So we learned a lot.  We talked about these issues.  And clearly, on
some of the issues like this we didn't get clarity.  But frankly, in a
stakeholder meeting process, we wouldn't exact clarity.  We wanted to
make sure that everybody had an opportunity to present their
perspective.

		One other thing that we did hear, which actually was not a dichotomy,
we heard virtually unity that safety and health, the Injury and Illness
Prevention Program should be applied universally to all employees.  And
we would appreciate this group's opinion on that subject also.

		As far as our next steps are concerned, having taken the information
from the stakeholder process and the research that the staff here at
OSHA has done, we're in the process of developing the paperwork to
initiate the small business, and this will be for process, which we hope
to begin next fiscal year.

		As I said at the beginning of my talk, this is one of Dr. Michaels's
high priorities.  He has encouraged us, like I said, to move out sharply
and I think we're in the process of doing that.  So we can expect to see
progress from one of your meetings to the next as we move forward.

		CHAIRMAN SILVERSTEIN:  Thank you.  Mandy?

		MS. EDENS:  Dorothy asked me to give you a little bit of update of
what we've been doing in terms of our -- I guess for lack of word I'll
call PEL's chatting.  I mean as most of you around the table know OSHA
has been thinking about a number of years and has several attempts in
the past to try to figure out how we can update some of our PELs that
were adopted in the early seventies when OSHA first came into existence.

		Those PELs were based at that time on data from the fifties and
sixties, and some cases, in a few instances, as early as the forties. 
And so I think it's no surprise that science has moved on and a lot of
chemicals we've learned that they have hazards that exist at much lower
levels.  So I think there's been a consensus for a number of years that
the PELs in OSHA 1910-1000 standards are somewhat outdated.

		And the agency has taken some efforts in the past.  In the late
eighties, we did have a rulemaking effort where we updated a number of
the PELs that we had on the books and added a few that we didn't have
PELs for.  And it was a fairly intensive rulemaking effort at that time.
 As most rulemaking goes, there were some who thought some of the PELs
were a little to stringent.  Some who thought a few of the PELs were not
stringent enough and they were challenged in the court.  And I think as
a surprise to some what typically happens when we get challenges they
remand back the things that are under challenge.

		And in this particular case, the court looked at the whole approach
that the agency took and vacated the entire standard.  And so we ended
up in that effort going back to our 1970s PELs.  And so since that time
with that decision in our lap, we said what is it that OSHA can do,
given the constraints that the courts have put on us?  What are our
opportunities?  There were some stakeholder meetings and it's time to
come up with lists and things like that.  And some of the people on this
committee probably participated in that effort.

		But it never really took hold and we never really got back on track
with another rulemaking. S o when Dr. Michaels came in, I think in
addition to try to spearhead the I2P2 effort and to reinvigorate our
general regulatory agenda he was also interested in other kinds of ideas
at the agency.  And one of them was to try to regain maybe or
reestablish some OSHA leadership in this areas.  Where there are a lot
of PELs conversations has been going on.

		And so what he did was formed an internal taskforce.  There are some
folks from the directorate in Standards and Guidance.  We reached out to
the Enforcement folks to come into the team.  There are some individuals
from our Office of the Solicitor and we had some folks from the regions
to try to come up and think of what are some of the range of options
that OSHA might pursue with trying to figure out to tackle this problem
of updating PELs.

		One of the first things we did, though, was to invite a select group
of stakeholders in and actually invited two folks from this committee. 
Peg was able to show up and I think Dr. Silverstein you were just coming
back from Safari, so you couldn't attend.  But we weren't trying to be
exclusive of a lot of people.  We didn't want to have a lot of series of
stakeholder meetings like Mike did for I2P2.

		We wanted to group some folks who really have been thinking over this
over the last decade or so.  And so we had a select group of people.  We
did go out to industry and academia and the unions.  But people who have
really have been thinking about this issue over the years and try to
frame some different conversations and get their input about how they
thought the agency should move forward, whether it's a regulatory or an
enforcement type of tactic.

		So we had some different ranges of options.  Some were a
substance-by-substance approach, trying to maybe identify a subset of
chemicals that OSHA would do some rulemaking efforts or enforcement
efforts on.  Then there were a category of options that dealt with more
control-based types of options, which would be I2P2 approach or maybe a
control-banning approach where you wouldn't necessarily look at
individual chemicals on a substance-by-substance, but try to have an
approach like a safety and health management system where employers
could look at all the chemical hazards in their workplace.

		And then the third category of options were what about instead of
these long-term options like waiting for an I2P2 standard or trying to
figure out how do control-banning maybe we could use some of our
existing authorities and use some of our authority under the
Occupational Safety Health Act, using the 5A-1 authority that we have or
maybe even amending 1910-1000 in some short ways to at least alert
people that the PELs are out-of-date.  I can't imagine that there are
people that actually think they're not.  But there is no really overt
way that we say that that anywhere in the regulation.

		So anyway, we have very lively conversations and most of the people we
invited like at the I2P2 stakeholder meetings they weren't shy, so there
was no loss for people putting ideas on the board.  A couple of the
ideas just short-term ones, one was maybe you should annotate the Z
tables to clearly show to people what the health affects those PELs were
based on so that they could compare that against existing health data to
show them how they might be actually out-of-date.

		And another short-term option or an idea that came up was maybe you
could solicit some input from the public to say what are the chemicals
that you think OSHA ought to be focusing on, whether it's in a
regulatory or enforcement mode.  So we actually did that last month
where we had a web forum.  It was open for three weeks where people
could write into the agency and nominate their favorite chemical and
describe why they believed OSHA should focus their efforts on those
chemicals.  So we shut that down just earlier -- I think it was last
week we closed off the website.  We got about 130 plus nominations.  So
we're going through each of those and we hope to post those relatively
soon.

		There are few in there that weren't really germane to the topic, so we
wanted to filter those out.  But we wanted to get a chance to see what
other people were nominating so they can see what ideas are out there. 
A lot of them won't be surprises to you.  I could share a few that came
up.  There were a lot of people that nominated different isocyanates. 
There were a number of people who looked at manganese, carbon monoxide,
styrene.  It shouldn't really come as a surprise because these were some
of the chemicals that were of concern when we were doing original
rulemaking.

		So what we hope to do is perhaps within the week I'm hoping is to get
these nominations up, posted on our website so you can see what people
are coming up with.  And then we'll go back and try to crawl through
those nominations and maybe come up with our own list and share that
ultimately with this group and with others to see what their thoughts
are.  And then we can start to think about some strategies about of
these range of options what would be the best approach that OSHA should
take.

		So I could see this committee maybe having some ideas about OSHA
should do that -- or what strategies you think OSHA should take.  And I
should say that of these strategies we never thought one of them was
going to be the way.  It might be a mix of options, doing some
short-term things now while you work on other long-term things or a mix
of enforcement and a mix of regulations, whatever fits the bill because
this really has been a long-term problem that we really haven't always
been able to get our hands around and I think Dr. Michaels would like
to, at least if he can't complete while he's here, to start us off in
the right direction.

		CHAIRMAN SILVERSTEIN:  Thank you.

		MS. SHORTALL:  I just going to give a three-minute update about
reaching out to vulnerable the workers and then that would be our
update.  And that is a follow-up the Latino summit, which was in the
middle of April, the 15th and 16th.  And I know Dr. Michaels reported
on the last meeting.  This is again a signature initiative of Dr.
Michaels and the Secretary of Labor.

		We really strongly believe that workers and employers have to be
educated about their rights -- workers about their rights, employers
about responsibilities, what the law says, what the standards say.  And
that workers should know that they can call OSHA.  They can call OSHA
for questions.  They can call OSHA to file a compliant.  And we've bene
focusing on reaching out what we call vulnerable workers who are not in
the mainstream of the organizations that we're used to reaching out,
whether that be labor unions or small associations.  These are workers
who are mostly in low wage, high risk industries and who we are really
focusing on.

		And I just want to give you an update that around the country all of
our regions have been adding these kinds of meetings and outreach to
what they do.  In New England there have been a series of meetings. 
They call it OSHA Listens when it's really for members of Latino and
other low-wage worker community where they're reaching out to explain
workers what their rights, educating them about job hazards, about how
to mitigate against hazards, about speaking up for hazards.

		In New York and New Jersey they are planning other summits and they'll
be on their website, so you know about it and come.  They had small
summit where they had a hundred people come.  I guess not so small in
New Jersey.  And they're doing another couple reaching out to Asian,
American Pacific Islander workers and also Latino workers in New York. 
We've gotten a number of alliances going in Chicago.  There were some
big meetings using community organizations, church-based organizations
to come together and to hold educational seminars.  So this is really a
big focus of our efforts that we've initiated since the summit and we
will continue with this and we will continue updating our website with
this.  And I'm happy to answer any questions about it.

		CHAIRMAN SILVERSTEIN:  Thank you.  Thanks to all three of you.  I
think you put stuff on the table that we'll come back to in our group
discussions this afternoon.  And this sets us up for a conversation with
Dr. Michaels tomorrow.  I don't want to take us into our scheduled lunch
hour, so Emory you had a question and a comment and then we'll break for
lunch after that.

		MR. KNOWLES:  This was just a relatively I think quick question on the
recordkeeping special emphasis program.  Have you found any significant
trends to date in under reporting based on what you're finding in that
program?  And secondly, what has happened with the emphasis on the
incentives programs in recordkeeping?  I heard a presentation where it
was alleged that there is no correlation between incentive programs and
under reporting.  So I'd like to hear your opinion.

		MS. SHORTALL:  Dr. Michaels is going to address the whole issue of
incentive programs tomorrow, which is why it was on the preliminary
agenda and then we realized he wasn't going to be here.  So he'll
address that tomorrow.

		In terms of the inspections that have been completed, there have been
around 80, 85 inspections that were completed and I think there are
about 45 percent that have had violations.  We just actually issued, and
this was not part of an NEP, an egregious recordkeeping case that you
can look at our website for it.

		So the research is still coming in.  We're still looking at the data. 
We another year to go and we have a lot of outstanding inspections out
there.  We have about a hundred that have been opened that haven't been
closed that we're waiting for results on.  And this is something that
the agency is really trying to grapple with.  We did initiate this
largely because there were a number of studies that did show a
correlation between certain kinds of incentive programs and fear of
reporting injuries and illnesses.

		There's a GAO study.  There was congressional interest and other
studies.  So we are taking a look at this and seeing what we found and
we'll report it as we go through this.

		CHAIRMAN SILVERSTEIN:  Thank you.

		MR. KNOWLES:  Point of order before we break for lunch?

		CHAIRMAN SILVERSTEIN:  It's got to be a very quick one, A Very quick
one.

		MR. KNOWLES:  I just wanted to make sure we have an opportunity to ask
questions of these folks.  Can they come back after lunch?  I mean I
don't want cut into lunch, but I also want to --

		CHAIRMAN SILVERSTEIN:  I understand.  Will one or all of you be
available?  At 1:30 Dr. Howard is going to be back to talk about flu. 
And then we're going to have a group discussion in which I'm sure we're
going to want to address some of these issues.  Will there be anybody
from OSHA available later?

		MS. SHORTALL:  It would be better for us, I think, if you want to
spend 10 minutes now and then just push lunch back 10 minutes.  Would
that work?

		CHAIRMAN SILVERSTEIN:  Peg is nodding her head.  I don't know that 10
minutes is adequate.

		MR. BUCHAN:  I don't think 10 minutes is adequate.  I've got a lot
questions.

		MS. SHORTALL:  You want to question us for more.

		MR. BUCHAN:  I've got lots of questions.

		MS. SHORTALL:  Okay.

		CHAIRMAN SILVERSTEIN:  I don't know.  I'm sure I'm not the only one
who has a number of comments and questions that I would love to get into
right now, but we are going to have to break for lunch.

		Dr. Howard is scheduled back at 1:30 and I want to give ourselves time
to eat and to get back.  Unfortunately, I don't know the range of topics
that people want to talk about.  Maybe if we just went around people
should just indicate what they --

		MS. SHORTALL:  Is there a time that you want us to come back for about
a 20-minute discussion?

		CHAIRMAN SILVERSTEIN:  What?

		MS. SHORTALL:  You want us to come back right after lunch because
there is a break right after lunch at 2:15 that you could probably work
through.

		CHAIRMAN SILVERSTEIN:  Yes, 2:15.  If one or more of you can come back
at 2:15 then we can pick up with some of this.

		MS. SHORTALL:  I'll let you know.

		CHAIRMAN SILVERSTEIN:  Great.  Okay, then we are going to break for
lunch and be back here at 1:30.

		(Whereupon, a lunch recess was taken.)

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A F T E R N O O N   S E S S I O N

(1:30 p.m.)

		CHAIRMAN SILVERSTEIN:  We're going to begin the afternoon session. 
Unfortunately, the technology is not working completely in our favor. 
The plan was to have a big screen.  Failing that, we had a smaller
screen that we were going to fill up.  But failing that, there's just a
small picture on a small screen.  So I apologize for those of you who
are in the back who don't have a copy of the PowerPoint that I think the
committee members have.

		Dr. Howard indicates that he willing to move ahead under these
circumstances.

		DR. HOWARD:  As Winston Churchill said, if you're going through hell,
keep going.

		(Laughter.)

		CHAIRMAN SILVERSTEIN:  Let me just indicate that we can send a copy of
the PowerPoint to anybody who would like it electronically.

		MS. BERKOWITZ:  A copy of the PowerPoint will be put in the public
record and you can get to it by just going to www.regulations.gov.

		DR. HOWARD:  Take out your telescopes back there and we'll give it a
whirl.  I just wanted to introduce the three major types of influenza. 
We all talk about seasonal.  This occurs every year and we don't really
pay attention to the fact that about 30,000 people actually succumb to
this every year.  Most of those people are in the older age cohorts and
we have a default setting there in terms of the amount of deaths that we
have in that regard.

		I say expected Avian Influenza.  That's the one that we hope never
comes due to H5N1.  Right now, if you look at the World Health
Organization cases, there's about a 60 percent fatality rate, which is a
eye-popping fatality rate for any disease.  So that's something that we
need to keep in mind.   And it is the background I think for which when
we discuss seasonal influenza, even though it's in a default setting in
our minds we need to think at some point we're going to have serious flu
here to deal with.  And all of our mechanisms that we talked about in
terms of protecting the population we should think with that background.

		And then this 2009 novel strain that probably isn't so novel anymore
that we had all of excitement with, and we'll talk about that more. 
Everybody I think knows about the major ways that influenza is
transmitted.  By direct contact, where we touch a formite like a
handrail on a metrorail or a door knob, et cetera and we end up
transferring varions to our mucus membranes.   We're essentially
self-inoculating ourselves.

		But then there's the large droplet transmission.  These are big
droplets and shorter range aerosols.  In this picture, which is an old,
old picture.  I like to show if you can imagine droplets that are
gravitationally very large.  They're falling very close to that cough
generators mouth.  But then you see way off in the distance there you
see a small cloud of small aerosols that may be going much further.

		The relative contribution of large droplets and small aerosols is a
continuing debate and it's one in which we are trying to solve.  And we
need to solve it because it informs, scientifically, a lot of our
protective mechanisms.

		Basic terminology, I want to go over three points, even if you're not
into medicine or infectious disease but to understand influenza.  One is
infectivity, which is a term that describes the virus's ability to
really infect human beings, okay.  Because influenza viruses are a big
family and they're pig viruses and duck viruses and goose viruses and
chicken viruses and all that.  So infectivity is extremely important.

		Once a varion has gained the ability to infect humans, then the next
thing is how transmissible is it.  How fast, how efficiently can it
spread from person to person?  H5N1 right now is very inefficient.  It's
a poor transmitter.  You have to live with a chicken, literally, to get
the virus.  It doesn't propagate very well from person to person.

		And then pathogenicity is the issue about what kind of bad things can
happen to a person if they should get infected.   We were very fearful
of the pathogenicity of H1N1 when it first came and we're certainly very
fearful of H5N1.

		Clearly, basic infection control you all know this.  Injury controls,
administrative controls like vaccination, personal protections, a lot
education and surveillance.  In healthcare, as Bill Borwegen mentioned,
this is a significantly increasing industry, especially in home
healthcare, et cetera.  And we have millions of workers involved in this
industry.  The attack rates influenza among healthcare workers really
vary all over the map.

		And I think they vary all over the map because we really don't have
enough really good studies about that.  But certainly OSHA has ranked
healthcare workers at highest risk of influenza exposure during the
latest season, the 2009/2010 season.  And I want to lead you through a
couple of history steps here to let you know how we got to where we are
today.

		The basic historical guidance that CDC issued is in 2007 on isolation
precautions, about preventing transmission and infections to the agents
in the healthcare setting.  So that's the default setting.  It contained
annual influenza for all eligible patients and healthcare providers.  It
contained guidance about standard and droplet precautions, active
surveillance, how to restrict ill visitors and personnel from hospitals,
use of antiviral and respiratory cough and hygiene.  These are the ABCs
that have been a part of basic influenza protection.

		In that 2007 guidance, I don't want to get too detailed, but it had
some information about droplet precautions for seasonal as well as the
Avian and any pandemic strain that we have.  It only basically talked
about respiratory protection in terms of a respiratory for a very narrow
type of exposures that are in that little 2f, 2a precautions during
aerosol-generating procedures.  So I just want to leave you with that
2007.

		And then we come to what happened recently.  So this is a graph that
shows you the number of influenza cases by various type that occurred in
the weeks of the years.  So when we look at the weeks of the year, this
first set of histograms there in that slide that we're looking at now
show the season that started at Week 50, 52 that's November, December --
December actually, the end of December.

		And then one is January, the first week of the year.  Three is the
third week, fifth is in February.  So that's the normal flu season.  You
get it at the beginning of December.  You go to January, February and
March.  By Week 15, you're pretty much done.  And indeed, before H1N1
came we were done with the regular flu season.  And then all of sudden
you see things that aren't supposed to be there.  That's supposed to
continue to be flat until the next season.

		Then all of a sudden in April/May, Week 17, 19, 21 we're seeing a
whole bunch of flu cases and we're seeing this new variant, H1N1.  So
all of a sudden we have another flu season in the middle of the normal
cycle, very unusual.  And that continued.  The peak went down about Week
25, 27, 29, 31.  And then just to go forward, we had then another couple
little hits that we thought were second and third wave.  They didn't
occur.  But that, essentially, is the H1N1 that started in Mexico and
swept around the world.

		So what happened then is that CDC released infectious control guidance
on May 13.  The story broke at the end of April in Mexico.  And
additional recommendations made to this basic 2007 guidance had to do
with isolation of confirmed or probably cases.  But the big issue for
respiratory protection was for the first time then the use of a fit
tested in '95 for patient care for confirmed or probably cases
happening.  So that was a ratcheting up of respiratory protection from
the 2007.  This is the initial interim guidance.

		The rational was lack of vaccine for this novel variant, lack of
innate population immunity to this variant, lack of data regarding
transmissibility.  We weren't sure how well it was going to propagate
and we didn't really know how severe it was going to be, so we didn't
know about the pathogenicity either.  So the lack of information was the
basis for ratcheting the respiratory protections.

		Then in October of 2009 an updated interim guidance was produced that
tried to narrow this down, firm it up.  We still were probably not as
well -- we didn't still understand as well as we should the
pathogenicity of the virus.  Still concerned about that.  And the
respiratory protections still were a part of that updated October 2009
guidance.

		But we were very concerned about the supply of respirators.  We got a
lot of input from healthcare facilities about we're going to run out, et
cetera, et cetera.  So in that October guidance, we added sections with
regard to shortage and prioritized use so that people could use
respirators in a judicious fashion.  We had hospitals saying we have
8,000 employees.  We need 8,000 respirators, et cetera.  And of course,
that is not judicious use of a respirator.  So we put that into the
October 2009.

		And then, as you can see here, we're going through time here of 2009
and 2010 all the way up to our latest data, which is August 28, 2010. 
And you can see here that we became -- this is the first blimp in the
histogram is the original flu season that we had.  Then came April and
May of 2009.  Then we had that huge increase and that second wave, which
worried us because as know in the Spanish flu epidemic there was a
second and third wave that was worse than the first.  And so we were
very concerned about that.

		Now things have stabilized and we're down to zero.  We're ready for
the next flu season, which will start here in October/November for
healthcare workers and later for the population because why do I say
healthcare workers get first because if you work in emergency room
urgent care you see the first patients in your community who have
influenza.  Healthcare workers are at a much greater risk because they
are taking care of the whole population.

		So at the end of the 2009/2010 H1N1 season, if you will, we counted 61
million cases and about 274,000 hospitalizations, almost 13,000
fatalities and 12,080 fatalities under the age of 17.  And this is very
unusual stuff and I'll show you a graph about that.

		This just gives you a baseline through a number of flu seasons
starting in 2006, 2007, 2008, 2009, 2010.  The red line is basically
what we're seeing in terms of the worst thing that happens when you get
influenza, which is you get pneumonia.  And you can see in 2008 it was a
bad season, and actually was little worse than 2010 in terms of
pneumonia.   that suggest the pathogenicity of H1N1 was not the worst
case scenario that we expected.

		Now this graph gives you some idea of where we see the fatalities that
are very unusual.  And this is 2006, 2007, 2008, 2009 and then 2010. 
And you can see all of those purple histograms are basically deaths that
we don't expect in pediatric populations.  So the younger population
unlike the usual in-seasonal flu where most of the deaths are in
individuals greater than seven-years old, we see a substantial increase
in this flu season in younger and younger folks.

		We have again from the healthcare worker perspective we have a lot of
younger healthcare workers now coming in.  We have a lot of population
that's retiring.  We have a lot of young healthcare workers.  And also
another sensitive issues in terms of increased risk was pregnant women
and a lot of young healthcare workers do find themselves pregnant.  And
obviously, that's something that can influence that.

		So in terms of the children and young adults issue, we have concluded,
although CDC hasn't done extensive studies in this, that the lack of
immunity, the lack of seeing this virus being born in the 1980s as
opposed to being born earlier and having seen some of the H1N1
relatives, if you will, in influenza season was probably responsible for
those fatalities.

		This is just a little slide about the H1N1 pandemic vaccination
campaign.  You can see that the doses of vaccine increased through time.
 This is October all the way through March.  And even though I'm not
trying to suggest there's a correlation between the orange cases and the
vaccine, certainly having vaccine available at the time of the outbreak
is critical.

		This year we expect the H1N1 vaccine, which will be contained in the
subunit virus to be available very early.  We expect H1N1 variant to be
the predominant variant and has essentially replaced all other variants.
 So we'll have vaccine available at an earlier time.

		Now the current activities there's new CDC guidance that is being
prepared and I think some of you may have seen that in the Federal
Register recently and solicitation of comments.  And then we are doing
some research that I want to go over.  And then I want to raise some hot
button issues that I think the committee needs to chat about and maybe
do more.

		The relative contribution of routes of infection I think, again, for
us in NIOSH is imperative that we settle that scientific question.  The
continuing question of appropriate level of respiratory protection we
need to get beyond that at some point.  The vaccination issue should it
be entirely voluntary?  Is there some room for mandatory vaccination? 
That's I think a public policy agenda item.  And then should CDC
guidance, which comes out on a voluntary basis, should that be made
mandatory?

		So I want to go over those three issues and offer those to the
committee for some thought, not necessarily all today but as we go
through time.  The flu season has a six to seven month time line, so
there's plenty of time.

		So on the first issue then of the 2010 updated CDC guidance, this was
a Federal Register notice on the 22nd of June and the comment period
went from the 22nd of June to the 22nd of July.  And the content is
essentially similar to the 2007, as I showed you once before in a slide
the isolation process.  Thee's N95 requirement as seen in the 2009
interim guidance.

		Airborne precautions are now extended aerosol-generating procedures
performed on patients with seasonal influenza.  So I think we've settled
that issue primarily.

		Currently, CDC is in the process of editing and finalizing the
response to comments.  And I don't have even an estimated date when it
will come out, but I think CDC will want it out before the flu season
gets into gear.  So I would expect it within the month.

		The rationales I think for changes in the respiratory protection
issues primarily are that vaccine is now available for H1N1 and the
pathogenicity that weren't certain about when this whole thing started
is better know.

		Now I want to turn to some of our research.  And again, I have to
apologize because I am a poor substitute today.  Dr. David Wiseman was
scheduled to do this talk in whose division of respiratory disease
studies in Morgantown this research as well as the health effects
laboratory in Morgantown are doing really wonderful cutting edge
research.  So I am just a poor substitute here.

		But I want to talk about this aerosol sampler that they've invented in
Morgantown to be able to sample in real clinical situations and be able
to get virus collected and analyzed.  The aerosol sampling was conducted
during the last flu season and we have every intent to fund this
activity.  And we have received funding from CDC to continue this
activity and every flu season as we through time in hospital emergency
rooms, in urgent care walk-in clinics, including dental clinics and
we're even hoping to expand it to home health situations, doing both
stationery were you station the sampler in an area of an emergency room
and you do personal aerosol sampling.

		The samples are analyzed using a test that looks for genetic material
that indicates a fingerprint for the virus.  The unfortunate thing, and
clinical infectious epidemiologists will tell you that's just fine that
you found some genetic virus laying around the emergency room.  But the
question is whether it could actually be a contagious particle and that
is the next frontier that we're trying to be -- in order to talk across
our disciplines we have to convince clinical infectious epidemiologists
that we are finding active virus that can product, not what they call
laboratory safety and health experiment.  These two papers are done in
clinical infectious disease from our folks in 2009 and 2010.  They're
already published, so you can look at those papers.

		Just to give you a glimpse of some of the findings.  We found a viral
RNA throughout the emergency department at the UVA emergency room and
the urgent care clinic in several different locations that we tested
during the last influenza season.  The exposure levels were highest in
the locations and at times when the patient loads were the heaviest.  So
that I think is good, sound epidemiology correlation.

		In the busiest day in the urgent care clinic, the airborne RNA was
detected in every room of the urgent care.  So you can essentially flood
an entire area if you have a cough generator with active viral infection
in your area.  Forty-two to 53 percent of the influenza virus RNA was in
the range that actually that is respirable when you get down to the LVOR
or the lower air sacks.  And again, this is from work by our folks in
Morgantown and published in 2009 and 2010.

		Now we're looking at some pending studies here where we're trying to
characterize the virus aerosols from the patient's coughing better. 
What is the distribution of particle sizes, et cetera?  We're trying to
do laboratory simulation of healthcare worker exposure to influenza by a
model, using an N95 respirator or surgical mask and trying to figure out
-- these are mannequin tests, modeling tests to try to figure out what
kind of exposure models best simulate the real world experience.

		So we're trying to develop and improve our methods.  We've built a
live virology lab in Morgantown and we're continuing to try to
characterize all of this research.  I think it's very exciting for us. 
As you know, we had a meeting in CDC in 2004 in December when we
broached some of these issues and we let many years go by before we
actually started doing this kind of research.  So I'm very happy that
this is happening.

		Now on these issues about the first question I asked about should
CDC's voluntary infection control guidance for healthcare institutions
be made mandatory?  This is an interesting issue.  And it's particularly
interesting because OSHA has placed on their regulatory agenda the idea
of doing an infectious disease standard.

		As you know, in California there is an existing aerosol transmissible
disease standard that was passed and so there is precedent for this
within the larger occupational safety and health community.  But that is
an issue in terms of the CDC guidance, which since CDC has been doing
guidance in influenza for years has always been fairly voluntary. 
Hospitals they didn't pay great attention to it.  Obviously, the  more
that the Joint Commission on Hospital Healthcare Organizations takes it
up as a review able issue, then it becomes very important.  But that is
an issue.

		The other issue is the mandatory influenza vaccination.  This is an
issue some members of the committee know was a very, very big issue in
the last influenza season.  Several groups have issued statements
favoring annual influenza vaccination as a condition of employment, and
I put a couple of them down here.  One is the Society for Healthcare
Epidemiology, and I have references here, and Infectious Diseases
Society of America, and then most recently the American Academy of
Pediatrics actually voted I think last week on this issue and I put that
in there.

		The Shay position papers are probably the more thorough in terms of
principled reasoning here.  They argue that healthcare worker
vaccination is an important patient safety issue and that voluntary
approaches haven't really worked and that the risk is small for
healthcare workers relative to the patient risk.

		This is also one of our most significant issues within healthcare. 
We're always trying to figure out what is the balance between patient
safety and healthcare worker safety.  And this is what makes I think the
healthcare industry a very unique industry in that regard.

		The same way the airline industry is interesting regarding
occupational safety and health perspective because we're balancing
flight attendant or crew safety and health with passenger safety and
health.  On a bus the driver's safety and health versus the passenger. 
So this is not totally unique, but it certainly becomes very sharp in
the healthcare world.

		The second point is that they take the position there's a moral
obligation for healthcare workers to get vaccinated, except when they
have medical contraindications like a vaccine allergy.  And they argue
that the benefits outweigh the concerns about coercion, impact on
employer/employee relations, blah, blah, blah as well as First Amendment
issues relative to individual, religious, or personal belief objections.

		As you know, in Occupational Safety and Health we are not devoid of
those issues.  For instance, wearing hard hats, given one's religious
orientation and head scarves, et cetera.  So this is not unusual, but
the First Amendment right based on religion that involve safety and
health.

		So it certainly is going to continue to be a prominent and very
contentious issue and I thank you for your attention.  And again
apologize that Dr. Wiseman is not here to better explain the research
that NIOSH is doing.

		CHAIRMAN SILVERSTEIN:  Thank you.

		Linda, you can start.

		MS. MURRAY:  Before we starting debating the debates, let me just say
that, as you've implied, we lucked up.  But there are some things that
are standard stuff that we didn't do from OSHA, NIOSH, and CDC that I
just want to bring up.

		First, CDC did not require health departments or physicians -- while
they did require us to document many things about who we gave the
vaccine to, they did not require documentation of race and ethnicity. 
And in the spotty reporting that we have, we know there was disparate
mortality rate and morbidity rate by race and ethnicity and age and
pregnancy.

		So again, the fact that in this day and age you would have a reporting
system that would fail to do that is more than distressing.  It's not
surprising and it's certainly true in or jurisdiction and all of the
jurisdictions that I know about -- local health departments that the
uptake of the vaccine is disparate by community, by racial and ethnic
community, particularly the African American community with extremely
low uptake.  Some of that is because people are suspicious.  Some of it
is because we don't have the resources to put it where it needs to be in
the right mechanism.  So that's a problem that I have just with
understanding the basis epidemiology.

		The other thing that concerns me -- two other things concern me is
that we didn't have any discussion about the impact of our national
policy on the epidemic.  So the fact that we still have an ancient --
that graph you showed where we got the vaccine too late to do any good
or to do much good I don't want people to miss that.

		So if the virulent had been higher, we would have major deaths.  The
vaccine supply would have come too late to prevent those deaths.  This
is for a couple of reasons.  One of which is that we're still using
ancient technology.  And again, as a scientific agency, not to suggest
that we -- I don't know if we're the richest any more, but whatever the
hell we are.  We have a lot of money for Afghanistan.  We should be able
to produce vaccine in modern methods.

		And the decision, which I understand considering the American culture
the decision to fail to use adjuvants in the vaccine, which means that
you have to have a higher concentration of the adjuvant vaccine in the
dosage you give people, not only is a problem for us but also dooms the
rest of the world to not having enough vaccine globally.

		Now again, this time we lucked up.  But had the virulence been higher,
our policy, stupid as it is not based in science, would have doomed
millions of people to death unnecessarily.

		Finally, what I wanted to say about workers, again before we start
debating some of these other more narrow things that we spend a lot of
time in H1N1 fussing about, we fail as a public health community to say
anything about stopping the transmission.  What would have been the most
effective method to stop the transmission, other than vaccine, would
have been to insist that every American worker have a right to sick
days.  Because we tell people cover your cough, stay home if you're
sick, have a right to sick days.

		And then of course one could have used up your sick days.  So when a
public health emergency is declared like this that involves a
communicable disease, it should have automatically triggered a mechanism
that automatically guaranteed every worker in this country paid sick
leave, if we were really serious about stopping this epidemic.

		So now those kind of basic old school, fundamental public health
approaches we didn't hear.  And this is a problem that just doesn't
impact healthcare workers.  Obviously, we're an extra high risk.  But it
impacts workers across all of our industries and to put people in a
position where they have not be able to take care of their loved ones or
go to work and risk getting sick or not be able to rest and get well
quickly because they have to pay rent is inexcusable today.

		And there were a lot of predictions and a lot of literature what
businesses going to do?  How do you have a business plan?  It doesn't
matter what your business plan is if you don't allow workers to get
paid, then they're going to come to work sick and they're going to
continue to spread the virus and they're not going to be able to get the
care that their family needs.

		So I found that very distressing and that's all I have to say.  And my
clinical friends this is a traditional tension, as you suggested,
between clinical infectious disease and occupational safety and health
folks about the masks and stuff.  I guess if you're really interested in
science that's nice.  But as far as I'm concerned, we don't really need
a whole lot of studies.  We should just use the N95 and be done with it,
but I'll leave that alone.

		CHAIRMAN SILVERSTEIN:  Peg?

		MS. SEMINARIO:  One issue that you didn't touch upon that was also a
major issue during the H1N1 outbreak was the surveillance of healthcare
workers.  And a continuing problem was the inability to identify cases
that were occurring amongst healthcare workers and then some follow back
to make some determinations of what the exposures had been.

		I know there were a couple of clusters that were examined, but just
for people who aren't immersed in the infectious disease world, those of
us who ended up becoming immersed in it because of H1N1 there a total
disconnect and different way of looking at the world between the
infectious disease community and the occupational health community as
Linda said.  And I think some progress was made in at least having some
communication on some of these issues.

		But there is a tension, a different world view that exists that
continues to create real difficulties here in trying to deal with the
worker issues and that were very much apparent early on with H1N1 and
are still very problematic.

		And the reality is you talked about that healthcare isn't different
when it comes to looking into patient safety or worker safety or
airlines or whatever, but the unfortunate experience in a lot of those
settings is that the worker's safety issues are secondary and that's I
think something that we saw here.  And from our perspectives in the
unions that NIOSH being in CDC was beneficial in some ways to have
communication, but also was difficult because they were somewhat
subsumed under the CDC and the infectious disease folks have a higher
presence in that agency and the orientation seemed to be much more
focused on infectious diseases.

		But one thing that I think that would be quite helpful that this
committee could look at, as I said, some of these institutional issues. 
Given these tensions, how do we basically get to the issues of
protecting healthcare workers against a major exposure?  That is OSHA's
responsibility.  It is NIOSH's responsibility.  And to look at this and
come up with some recommendations so that the occupational health issues
have a prominence.

		There's a very active advisory committee that exist within the CDC
structure called the Advisory Committee on Infectious -- whatever that
don't have really occupational health people on it.  So all the advice
that's coming through again is putting the worker issues secondary.

		And so one of the questions is you going to be having advice coming
forward to advise OSHA and NIOSH on the worker issues this might be a
committee to look how do we get that voice, either this committee or
some other way to provide that voice?  Because right now it doesn't
exist.

		CHAIRMAN SILVERSTEIN:  Bill?

		MR. BORWEGEN:  It seems like what's going on here is this is like in
Yogi Berra's terminology deja vu all over.  I recall when we petitioned
OSHA for the blood borne pathogen standard in 1986 -- well, first of
all, the dentists said nobody wouldn't go to the dentist if they wore
gloves and no one would go today if they didn't.  We were was that we
were proposing a comprehensive infectious control program for blood
borne pathogens and we were told that, no, you just need the hepatitis B
vaccine and you can trash the rest of the standard.  You don't need
anything else.  And that vaccine is actually quite effective.  That's a
vaccine that's 99 percent effective like a lot of the other vaccines.

		The flu vaccine is singularly unique in being less effective.  It's
only 90 percent effective.  I think you need to add to your PowerPoint
that the H1N1 vaccine is only 62 percent effective.  That was reported
to the ASIP committee.  I don't know why it's kind of a secret, but it's
a state secret, I guess, except the ASIP committee knows about that.

		So now we're putting all of our eggs in one basket of the vaccination
with 13.7 million healthcare workers.  That means that even a 100
percent of healthcare workers got vaccinated we'd have 5 million
healthcare workers, including many pregnant healthcare workers that
would have insufficient immunity against the H1N1 virus, which has a
differential pathogenicity which you capture and which cannot be
emphasized enough that 95 percent of the hospitalizations and the
fatalities are people that are under the age of 65, which is the exact
opposite for regular seasonal influenza.

		I think we're mixing things up here.  I think the CDC is now proposing
to treat this as regular seasonal influenza when that is not the case. 
The vaccine, they're overselling the effectiveness of the vaccine and
the bottom line is this a working person's disease.  This is why it's
the purview of this committee.  This disease is particularly affecting
working-age people.

		And there are some interesting studies out there already.  I mean
there's a study in New York that found, for instance, that the folks
that worked in the ER had H1N1 infection rates two and a half times
greater than other people that worked in that hospital.  And so that
illustrates to me that this is transmitted in the workplace, and I'm
anxious to get these reports on these other clusters.  And I think what
NIOSH could do is capture all of this healthcare worker cluster
information from all of the different states, from Wisconsin, Chicago
and we've heard about a number of other clusters to figure out what is
going here.

		You know, the CDC was adamant that they were not going to collect
information on whether or not a person was a healthcare worker.  Last
year when we had weekly phone calls we said we really need to capture
this information.  I agree with Linda.  We need to capture the
information on race and ethnicity as well.  There's a large percentage
of the -- there's significant underparticipation from African-Americans,
I can tell you that right now.  We had a worker last year who was just
fired because she didn't get the seasonal influenza vaccine under a
mandatory vaccination program.  Well, seasonal influenza didn't even
exist this past flu season after the initial outbreak, but she was
fired.  So we're starting to see more of this, of workers being fired or
workers being told they need to wear surgical masks if they don't get
the vaccine kind of like a scarlet letter.

		And all I can tell you about the Shay paper, I mean, I read it and I
read it very carefully because I read it, and I thank Sarah Shortall for
making me look more carefully at conflicts, but the bottom line is
factually people need to know that five of the nine authors receive
money from vaccine manufacturers.

		And this is not atypical among a lot of these infectious control
groups and individuals that are involved in this campaign where they
want to trash N-95s, but they want to mandate or fire healthcare workers
who don't get the vaccine or make them wear surgical masks, and I think
NIOSH could also help us to show whether or not the wearing of a
surgical mask somehow is protective, because my gut tells me that if
you're required to wear a surgical mask for eight hours a day or 12
hours a day depending on how many hours you work, if you don't get the
flu vaccine, then every time you touch your mouth to readjust the
surgical mask you're perhaps transmissibility, so that would be an
interesting question.  I saw that the president of Shay did recently say
that there was no efficacy data to show that the wearing of a surgical
mask by a worker, a healthy worker, was protective, and that's why they
think now you should fire people if they don't get the vaccine even for
religious objections, which is a violation of the EEOC guidance on the
topic.

		So this is quite a controversial area to say the least.  I think you
pushed some hot buttons, but our bottom line is I don't know what this
group wants to do or could do, it's a very complicated area, but
requiring 100 percent vaccination for a vaccine that's only 62 percent
effectiveness seems to be overkill and overreaching while at the same
time you're going to trash the ability of a pregnant healthcare worker
who may have gotten vaccinated but the vaccine didn't hold, she needs to
go into a room of a coughing patient and she will not be allowed now
under the new CDC guidance to request that she wear a fitted N-95
respirator, and I think there's something wrong with that picture.

		CHAIRMAN SILVERSTEIN:  Thank you.  Dr. Howard, I appreciate your
putting the three hot button issues on the table, and I've got a
question about one of them which really goes to one of the issues we
were discussing earlier having to do with the relationship between NIOSH
and OSHA.  One of the questions was whether or not the CDC guidelines
should be mandatory.  Well, I don't think it's a stretch to say that
insofar as OSHA last year issued a compliance directive that then became
the basis for inspections and citations that incorporated the N-95 and
other of the guideline elements that the CDC guidelines have been
mandatory in the OSHA context anyway.

		Now what I'm wondering is this, and I'm glad that Rosey is in the
audience and Debbie is back there because they may know the answer to
this.  If in fact CDC changes its guidelines so that N-95s are no longer
part of the guidelines, what's going to happen, what does OSHA intend to
do with its compliance directive?  Will it keep the N-95 requirement, or
will it follow CDC?  So the relationship here between NIOSH insofar as
it's part of CDC and OSHA really becomes a very tricky one and one that
I think bears examination.

		DR. HOWARD:  Well, sure, and you know the question probably could have
been more precisely stated, should OSHA rely solely on the CDC
recommendations as a basis for an infectious disease standard or should
it on its own go beyond that or add things that aren't included in the
CDC guidance, or in other words, will it just adopt or incorporation by
reference if you will.  So the issue is, is there another way to do
infectious disease standards and all that.  That I think obviously will
come up in the public policy discussion around this regulatory agenda
item.

		CHAIRMAN SILVERSTEIN:  Okay.  That helps clarify or make the issue
more precisely stated.  Peg?

		MS. SEMINARIO:  Just a point of information for others on the
committee.  The other problem that we ran into during H1N1 was while CDC
put guidance forward with respect to protection for healthcare workers
that it wasn't mandatory.  Different state health departments had
different guidance, and one of the questions was then for the head of
OSHA in those states, which basically had different guidance as to
whether or not they could enforce, and so there are a lot of different
issues that were in play because there was no standard.

		So the enforcement would have been under the general duty clause,
which basically requires that there be a recognized hazard and also
certain industry practices, and the fact of the matter was is that you
had conflicting guidance coming forward from CDC at a national level and
a number of the state health departments, so it really complicated
things, and then add on top of that some of the states were fed OSHA
states, some of the states were state plan states, and so it became a
real issue for workers in terms of what kind of protection they not only
should be afforded but they could legally basically say we had a right
to, and so it was a real difficult situation for healthcare workers
depending upon what state, what health department, which OSHA was in
play.  It was sort of a mess.

		CHAIRMAN SILVERSTEIN:  And let me raise another interesting question
about relationships which has to do with the relationship between OSHA
and the state plan states.  OSHA issued its directive and all of the
state plans were required to develop directives that were at least as
effective as what OSHA had.  Now, in our state, we adopted something
that was virtually identical, so there wasn't much question, but I don't
know whether or not OSHA applied its discretion with regard to the
states in a uniform way or not.

		MR. BORWEGEN:  Well, there's a missing piece to that.  I think we need
to again for the committee's benefit, in order to come to a resolution
on this issue, NIOSH and CDC and OSHA in their wisdom did commission an
IOM panel that looked at this question and they turned around very
quickly and they in a very quick turnaround produced a letter saying
that based on what they know about transmissibility and that there's no
reason to assume that there is not at least partly an airborne component
to transmissibility that fitted N-95s should be the minimum level of
protection, so that's why I'm having even more trouble with the CDC
revision, because they contradict what the IOM found.  And again we can
argue that this disease was not as -- you know, the pathogenicity was
not as severe as we thought it would be, but I still think 30 to 36,000
fatalities a year is not insignificant.

		CHAIRMAN SILVERSTEIN:  Yes.  Well, I'd like to see who else on the
committee has something to add to this, and then we're going to move on.
 Emory?

		MR. KNOWLES:  Just a basic comment.  You mentioned the state plans. 
They have up to six months to adopt a change.  By then the season is
over.

		CHAIRMAN SILVERSTEIN:  Right.  I mean, that was the way it was last
year.

		MR. KNOWLES:  So you have protections for half the population and for
the other half you don't.

		CHAIRMAN SILVERSTEIN:  It could be.  Debbie's going to be up here in a
minute.  You placed some provocative issues on the table, and what I'm
wondering is what regarding influenza NIOSH and/or OSHA feel that this
committee might be most helpful in addressing.

		MR. BORWEGEN:  Well, for NIOSH's sake, I mean, any issue related to
seasonal influenza and healthcare workers is to me open.  It depends on
what you guys want to focus on, but we welcome all advice.

		CHAIRMAN SILVERSTEIN:  Okay.  Fair enough.  Okay, anything else
specifically on influenza?  Peter?

		MR. DOOLEY:  One addition to Linda's comments about the sick days. 
Even workers that have paid sick days, increasingly over there's a
system set up to discourage workers to use those sick days.  And that
has gotten more and more severe over time.  So there's a lot of polices
that are set up with companies that literally discourage against the
appropriate use of sick days in a situation like this that affects
public health.  So that's just an issue that we have there.

		CHAIRMAN SILVERSTEIN:  Looking at the agenda, we've got two things
that are remaining to be done.

		DR. HOWARD:  I'm going to just apologize to the committee.  I have to
run for a 4:00 flight and I won't be here tomorrow.  Frank Hearl will be
here to hear any comments that you have or suggestions for us
immediately and any other plans, any other support you guys need.

		CHAIRMAN SILVERSTEIN:  Let me say on behalf of the committee thank you
very much for spending this much time with us, very informative, very
useful.  You've given us a lot of stuff for us to think about and I hope
that we can meet your expectations in providing you useful advice.

		DR. HOWARD:  You r last letter I think was very helpful.

		CHAIRMAN SILVERSTEIN:  That's good feedback.  I appreciate that.

		DR.  HOWARD:  All right.  Thanks.

		CHAIRMAN SILVERSTEIN: There are two things that we may be able to do
simultaneously.  One was some follow-up discussion with OSHA about the
issues they'd placed on the table.  And then secondly, we had time set
aside for open discussion among the committee members about issues that
we might want to take up, either in subgroup or otherwise.  I think that
those kind of blend together.

		It may be time for a five-minute break before we --

		MS. BERKOWITZ:  We were supposed to start at 2:15.

		CHAIRMAN SILVERSTEIN:  Then we'll just continue with you.  I think
that Sarah had some housekeeping stuff.  Why don't you hold that until
after we have this continued discussion with Debbie Berkowitz?

		MS. BERKOWITZ:  Thank you.

		CHAIRMAN SILVERSTEIN:  And Mike and Mandy.

		As the three of you left earlier there were a number of committee
members who had burning questions or comments to make.  And so I open
the floor up again to anybody who wants to pursue the conversation with
OSHA.  Yes?

		MR. BUCHAN:  I will start off with PEL.  And what I'm about to say is
probably very naive.  But if you go back and read the original OSHA Act,
NIOSH was required to develop criteria for chemical exposures and OSHA
was required to adopt those as standards.  My question is, is why OSHA
cannot say we are mandated by the OSHA Act to adopt the RELs?  That's
probably naive, but it's just a thought?

		MS. BERKOWITZ:  I think that's a great thought, but I think that in
practice there haven't been that many criteria documents.  I mean the
larger issue is there's so many substances out there.

		MR. BUCHAN:  But you have a lot of RELs.

		MS. BERKOWITZ:  But I'm not an expert on Occupational Safety and
Health Act, although I've worked here for 25 years.  But I think there
still is an obligation on the agency to through rulemaking.  So even if
they gave us a criteria document, there is not, I don't think, a blanket
authority to just take it.

		CHAIRMAN SILVERSTEIN:  I think you're right.  Sarah's looking at the
Act.  I think I remember this that the statutory requirement is for
NIOSH to develop criteria for rulemaking and for OSHA to go through the
rulemaking process before it can issue a rule.  So it was never intended
to be automatic.  But I think it's fair to say that the congressional
intent was for the NIOSH criteria to be used in a much more deliberate
an serious way than has evolved over the years.  I think that the
circumstances developed was that OSHA develop its own rulemaking group
that went beyond what congressional expectations were.

		MS. BERKOWITZ:  Could I add one other thing here under the Act.  Mr.
Buchan, when Congress established the Occupational Safety and Health
Act, Congress delegated to the Secretary of Labor making standards and
rules.  And that's why in the Act it talks about NIOSH presenting
recommendations on criteria to OSHA.  But if OSHA was simply to blanket
adopt something like that without doing its own looking.  In essence,
that becomes a violation of the delegation of authority.  The only one
to whom this authority to issue safety and health standards across the
board, across all workplaces is to OSHA and not to NIOSH.

		Similarly, although our Act has a great preference for us to adapt
national consensus standards, we just don't in and of themselves adopt,
that we conduct a rulemaking.  We do have an obligation if we choose not
to adopt a consensus standard explain why we're not doing so and why we
think what we would be doing would be more effective for workers.

		MR. BUCHAN:  Okay, I said it was probably naive.

		MS. BERKOWITZ:  Not actually.  I mean I think that what Dr. Michaels
and Dr. Howard are trying to do is try to figure out how we can work
more collaboratively so that when they do develop the information that
we can either put that into use in terms of regulation or other efforts
that the agency has.  And I think as this PELs conversation goes on we
would be interested in ideas or a way in which we could more effectively
use NIOSH either to conserve some of our resources.  I mean right now
we're working on a rulemaking project where they're actually doing the
risk assessment for us.  So there are some opportunities I think where
the leadership of NIOSH and OSHA of trying to figure out we can use that
expertises so that we can speed up and address however the need has
been.

		CHAIRMAN SILVERSTEIN:  I appreciate that.  I think that the
relationship has gone up and down over time.  There are periods of time
in which OSHA has taken NIOSH recommendations quite seriously and other
times when OSHA has simply set them aside and not addressed them at all.
 And I'm very glad to hear that Dr. Howard and Dr. Michaels are
interested in rebuilding a very strong relationship that will result in
effective rules.  How to do that is a challenge that perhaps we can be
helpful with.  Peg?

		MS. SEMINARIO:  Just another point of information.  OSHA is also
required under the statute and under a whole variety of other statutes
and executive orders to have a much more robust -- to make a finding of
feasibility, both technological and economic feasibility, which doesn't
come through in the RELs and then to come forward in terms of regulatory
analysis.  There's a whole set of other requirements here.  And always I
would say that the vast majority of cases with respect to standards the
agency has reached feasibility constraints before it deals with risks. 
So the standards aren't set based upon protecting workers from risk. 
They are set because they reach a feasibility constraint.  And that
really is a huge area of resources and time and energy and a level of
analysis that is actually much more intricate and difficult at a much
more refined level than the risk assessments.  So there's a lot to do
here in addition to taking up the standards.  But I had a question.

		CHAIRMAN SILVERSTEIN:  Yes.

		MS. SEMINARIO:  On the Injury and Illness Prevention Program, I2P2
rule, are you looking at a rule?  You had said that most of the
stakeholders recommended that it apply to all employers.  You're talking
also then about all sectors, correct?

		MR. SEYMOUR:  That's correct.

		MS. SEMINARIO:  Because I think that's really important because one of
the things OSHA has done over the years, unfortunately, is with many
rules they only apply to one sector and then you never get back to
protecting the other workers.  And here you've got an opportunity, not
only in general industry, but in agriculture I'd say that this is really
critical, in maritime, in all the sectors where you operate and you have
authority that having a standard of broad application and whether it has
to have certain provisions that might have more import in application,
such as dealing with multi-location workplaces or multi-employer
workplaces.  Those things need to be dealt with as well.  But I think
dealing with a broad-based standard is really critical.  And I would
like to know whether the thinking is to have a broad-based standard?

		MR. SEYMOUR:  Our current thinking is we haven't honed down into
looking at specific sectors at this point.  And our preliminary drafts
of a potential rule do tend to be as broad as possible to cast as wide a
net as possible.  And there are some issues that need to be addressed. 
Certainly, construction is one issue where there's not a fixed worksite
and a highly mobile workforce where they have some specific issues.  But
it's our hope that we can write a set of requirements that apply to
everyone to make sure that everyone gets the protection associated with
this kind of universal intervention.

		CHAIRMAN SILVERSTEIN:  Other comments?  Bill?

		MR. BORWEGEN:  A short question.  So when is the rule going to come
out, the draft?  And then I have another question, another comment.

		CHAIRMAN SILVERSTEIN:  Okay.

		MR. BORWEGEN:  So are you going the SBREFA process?  The fiscal year
starts October 1, right?

		MR. SEYMOUR:  We're certainly planning to put the SBREFA process in
place early in the fiscal year.  I can't put a particular date on it
yet.  That's really not my position to do that.

		MR. BORWEGEN:  Your colleague to your left can answer the question.

		(Laughter.)

		MR. SEYMOUR:  Well, notice I didn't give her the microphone.

		MS. BERKOWITZ:  Sorry.  I wasn't paying attention.

		MR. SEYMOUR:  It's our intention to move this on as quickly as
possible.  And I think we're putting in place the mechanisms to do that.
 Certainly, the SBREFA panel is something that we need to learn from
before we can put a final rule or, I'm sorry, a proposed rule in the
Federal Register.  But we are working as quickly as we can to be able to
get this out as quickly as possible.  I'm sorry for the bureaucratic
answer.

		MR. BORWEGEN:  Okay.  Well, that's fine.  But history is replete with
examples where we waited too long, so I know you share our zeal to move
forward quickly on this.

		The other area is I really like this thing you're going to be doing
together with DOT with texting, but I'm wondering about talking on a
cell phone or even the handset free.  And I'm wondering how far you
could go.  I mean could OSHA, for instance, recommend that employers
change their workplace policies so that workers do not text while
driving, or talk on cell phones while driving or even with hand-free
sets.  I'm thinking back to the days when Johnson & Johnson was a leader
in promoting the seatbelt us.  But I mean it would be nice -- I know
because we just changed our policy where I work and I was involved in
writing that forbids the use of even hands-free headsets.  I don't know
how well it's enforced, but except for emergency use.

		CHAIRMAN SILVERSTEIN:  Can you address that, Debbie?  Can you address
that question.

		MS. BERKOWITZ:  Yes, I'm going to address it.  Are you done?

		MR. BORWEGEN:  I'm done.

		MS. BERKOWITZ:  Yes, I think we're looking at all distracted driving
and I think what we're doing is we're going to focus on texting first
because that was the subject of President Obama's executive order last
week about no texting.  You know have to start somewhere in the federal
government.  Thirty states have passed -- prohibiting texting rules
already.  It's what the Department of Transportation has issued a
proposed rule in April and should become final shortly on prohibiting
texting while driving for commercial carriers.  They govern trucks that
are 10,000 pounds or more.  So now we're looking at what OSHA can do in
our jurisdiction and starting with prohibiting texting while driving,
but also prohibiting policies that require workers to text while driving
or either officially or unofficially they have to do it order to make
their quotas.  So that's what we're looking at and then expanding from
there.  So yes, I think we're just beginning this process and we're just
starting with texting while driving.

		CHAIRMAN SILVERSTEIN:  Joe?

		MR. VAN HOUTEN:  It's an offer for OSHA.  Could you think about
expanding it to hand-held devices rather than just texting because you
have GPS units?  You have computers.  You have things that are just as
dangerous as texting.  So it's just an offer to not just limit it to
texting, but think about the initial focus being on hand-held devices.

		MS. BERKOWITZ:  Right.  The Department of Transportation rules are all
devices that are brought into the vehicles and those are the hand-held. 
And I think we're thinking at following that.  That's what the executive
order is too.

		CHAIRMAN SILVERSTEIN:  Emory?

		MR. KNOWLES:  Emory Knowles.  I would also strongly suggest that you
incorporate into the educational program an emphasis program for teen
workers.  Even though many of them aren't drivers, need to be reach the
younger generation that is overwhelming all of us with all of these new
technologies.

		MR. BERKOWITZ:  I don't want to give away the Secretary's whole speech
on Tuesday, but one of the key focuses and I think the areas that we can
really be very effective and partnering with the same people we do on
other job hazards is with reach out to teens in high schools and even at
younger ages about this and other occupational health hazards.  And we
happen to have a new, young worker specialists that we stole from Mike
Silverstein's Washington OSHA coming to join our OSHA next week in our
occupational health-nursing department.

		CHAIRMAN SILVERSTEIN:  Peter and the Peg.

		MR. DOOLEY:  Mike, I was glad to hear that the near miss or however
you want to call it, near hit or close calls is still on the mark in
terms of in the proposal.  And I wonder if there's any thought to
including a provision about no disciplinary action can be associated
with the reporting of near misses, since that's a huge issue that has
been recognized as far as influencing those systems.

		MR. SEYMOUR:  We certainly had a large number of conversations here
within the agency on that topic.  It does seem clear to us that any form
of retaliation, discrimination, whatever reduces the likelihood of
employees to be involved and be fully engaged in such a process is
something that we need to be serious about address.

		MS. SEMINARIO:  A couple of comments here on the issue of texting
while driving.  I think it's fine for the agency to be involved with
this, but I would just caution you based upon may decades of experience
in dealing with issues that are broad-based and where there are other
agencies that also authorities and responsibilities that there are
certain things that OSHA and only OSHA does.

		Nobody else controls exposure to chemicals in the workplace.  Nobody
else is dealing with confined spaces and lack of tiedown and workers are
being killed, falls.  And I would just caution you.  This agency has
limited resources, so to keep things in perspective and not just look at
the flavor of the month or the year.  I mean these are again important
issues, but you've got to set priorities.  And where you have other
agencies which have bigger budgets that have whole initiatives and
people and staffs devoted to these things to keep things in perspective.

		We went through experiences back with Jerry Scanlon dealing with
seatbelts.  The agency tried to work in that area here and got their
heads taken off politically because there wasn't anybody else -- I mean
there were other forces, people that could have taken that on, but you
couldn't.  The same thing happened on indoor air and smoking.  And there
are implications where with respect to the agency and preemption.  When
you start operating in workplace issues, then a state doesn't have the
authority.  You take away their authority once the feds issue a
regulation in an area.

		So I would just again caution you to keep this in perspective as far
as who else has authority?  Who can bring what to the table here and not
necessarily -- again, think about those things where you have a unique
role, are the only ones.  And we talked a lot about chemicals and you
haven't been able to address that.  And to caution you to again just
keep things in perspective with respect to authority resources and other
competing priorities.

		CHAIRMAN SILVERSTEIN:  I know that you have t leave soon, but I'd like
to comment very briefly on the comments that each of the three of you
made earlier.

		First of all, Debbie, you gave us a number of enforcement-related
examples, the SCEP Program, the recordkeeping NEP, the grain-handling
letter that you sent out.  In each case the actions that federal OSHA
took required action by the states that had state plans.  And so
speaking for a second as a state plan administrator, I would just urge
OSHA to be more attentive to the need to have discussions about those
things a bit earlier than has been the case recently.  And I think that
can be done without ceding your authority to make decisions in a timely
manner, which is really important.  But I think that there are
opportunities to strengthened the federal/state relationship on these
kinds of issues.  We really had to rush, for example, with regard to the
grain-handling letter, which took us by a greater degree of surprise
than I think was necessary.  So there's some improvements that could be
made.  So we just offer that suggestion.

		With regard to I2P2, I appreciate the breadth of the approach that
you're taking, touching all the basis with regard to the elements of a
management program, but I think that the heart of this is what you
described as find and fix, the obligation to identify hazards and once
recognized to have a plan in place to control them.  If that element is
either absent or weak, none of the rest of it matters.  And I think you
ought to focus a great deal of attention on that piece of it.  I think
that's the heart of it.  That's a personal view, but I offer that to
you.

		With regard to PELs, I understand and I would support OSHA moving
ahead on some specific chemical rules, whether it's just improving some
of the PELs by themselves or more comprehensive rules for a control of
chemical hazards.  But I really support the broader approach that I
think that you described in which you said that no one approach is going
to work, that you have to really do a number of different things.  If
all the agency does is focus on specific limits for individual
chemicals, it's equivalent to what I've thought of for a number of years
as trying to seasoning your food one grain of salt at a time.  You're
never going to get done.  I mean we're talking about tens of thousands
of chemicals and spending resources on doing complicated rulemaking on
one at a time just doesn't even come close to meeting the need.  So I
think you've got to be thinking about things quite seriously like
chemical banding or controlled banding or other methods that are going
to address numerous chemical hazards at the same time, otherwise you're
just not coming close to addressing the problem.  So I would just offer
those suggestions to OSHA.

		How much longer do you have?

		MS. BERKOWITZ:  I have until three.

		CHAIRMAN SILVERSTEIN:  Okay.  There were other hands up.  Joe?

		MR. VAN HOUTEN: I just wanted to offer a counterpoint to Peg's comment
about fleet safety.  I work at a company that has been very fortunate
not to have a fatality in our manufacturing facility for over 25 years. 
During that same period of time we've had 20 employees who have been
killed in traffic accidents.  Preventing the next fatality at Johnson &
Johnson means that we want to have a very effective fleet safety program
in place.

		This group of employees, employees that drive on company business,
drive a company car on company business is currently not covered by any
standard.  You have the DOT that it meets commercial drivers, but below
that there is no standard.  I had one employee unfortunately who was
killed in a car accident.  And when I notified OSHA about the fatality,
there was no interest by OSHA in that fatality and I think that's a
shame.  And that's why I think that there should be stronger interest on
the part of OSHA to be interested in employees that drive on company
business, drive company cars on company business.

		CHAIRMAN SILVERSTEIN:  Bill?

		MR. BORWEGEN:  And I forgot about these bad situations with indoor air
quality and what were the others.  I think we can learn from Peg's
wisdom and my failure to remember some of these struggles.  But I also
concur with Joe.  So I think what we need to do is you need to try to
get DOT to carry as much of this water as possible.

		MS. BERKOWITZ:  Sure.  Right.

		MR. BORWEGEN:  And to the degree you can stay in the backseat, no pun
intended, DOT has really got to be out front on this and but you could
help inform and educate them about these situations.

		MS. BERKOWITZ:  Right.  And that's what we're planning on doing.

		CHAIRMAN SILVERSTEIN:  Other comments, questions for OSHA?  One last
one, Peg.

		MS. SEMINARIO: It's a different issue here and that is going back to
the national emphasis program on recordkeeping.  You'd said that you're
looking at modifying the targeting criteria.  Can you talk a little bit
more about what the issues were involved in the initial directive and
what you're thinking about now because this is obviously an area of
great concern and I think the approach that was taken to begin with was
pretty narrow.

		MS. BERKOWITZ:  Right.  I think that's what we felt.  I think with
every NEP that OSHA has that last for a while you tend to look at where
you're going and then decide let's shift the universe a bit.  And right
from the beginning we actually thought about that.  We thought that we
would have this go for a while and then we would shift it a bit.

		I believe that everything is almost -- we had to reconfigure the
computers, but everything should be ready in the next couple of days. 
What we were looking at is slightly altering who would be subject to it.
 Right now it's only employers that have the lowest injury and illness
rates.  And that's where we were looking because there was a thinking
that that's where we would find some recordkeeping violations if they
were in high-hazard industries.

		And so now we're looking to broaden that a bit and not just the people
with the lowest injury and illness rates, but that have a little bit
higher, but are still below a certain number based on the GAO report,
based on everything we've read of where the violations are and also
trying to look at some larger facilities also and build that into the
mechanism of focusing.  That what's will take us through the next year
on this.

		CHAIRMAN SILVERSTEIN:  Thank you.  Anything else?

		(No response.)

		CHAIRMAN SILVERSTEIN:  We thank you very much.  We will continue to
talk about some of these topics with Dr. Michaels tomorrow.

		MS. BERKOWITZ:  Yes, he'll be here all day.

		CHAIRMAN SILVERSTEIN:  This sets us up very well for that conversation
with him.  So I appreciate.

		MS. BERKOWITZ:  Thank you.

		CHAIRMAN SILVERSTEIN:  We're not doing badly.  We're a bit off and
need to do some retooling for the rest of the day, but we're not doing
badly here.

		What I had anticipated for the rest of the afternoon, starting at
2:30, which has long gone now.  What I was anticipating was an hour for
us to have a discussion with the whole committee about topics that might
be appropriate for further work in addition to the continued work on the
Gulf Oil situation and then for the last hour to break into at least two
groups, probably no more than three, but two groups.  One would be Gulf
Oil and the other would be some topic that we would have decided in the
group discussion.  But I'm not sure that we have time to do it that way.
 So what I'd like to do is take a break now, a 10-minute break and then
come back and let's have a conversation about how we can most
effectively make use of the rest of the day and tomorrow morning.  So
during the break think a little bit about how we can organize the rest
of the day.

		(Whereupon, a short recess was taken.)

		CHAIRMAN SILVERSTEIN:  I'd like to go back on the record and Sarah as
a couple things to add.

		MS. SHORTALL:  Okay, Mr. Chair, I'd like to add a few more exhibits to
the record.  As Exhibit .23, the NIOSH Influenza Update PowerPoint
presented by John Howard.  As Exhibit .24, the CD distrusted to NACOSH
members containing NIOSH scientific information products.  As Exhibit
.25, 11 brochures of NIOSH informational material basically entitled A
Story of Impact.  And as Exhibit .26, comments on the CDC Guidance for
Prevention Strategics for Seasonal Influenza in Healthcare Settings from
Bonnie Rogers, Director of North Carolina Occupational Safety and Health
and Education Research Center on behalf of the National Occupational
Research Agenda Healthcare and Social Assistance Sector Council.

		With regard to Exhibit .24, what we will also be doing for the
informational record is inserting into the record a list of all records
that are on that CD and hopefully, hyperlinks to all of them so that any
member of the public would be able to get access to those documents.

		CHAIRMAN SILVERSTEIN:  Okay.  Thank you.

		I need the committee's help on making an operating decision here.  My
hope was that by this time today we would have identified one other
subject that was a good possibility for an additional workgroup and that
we would take an hour at the end of the day here to break into two
workgroups, one being the Gulf Oil and the other being the other subject
and we would have had an hour to discuss those and then we could
continue that discussion tomorrow.

		We're clearly not there yet.  So there are two options that I would
pose to you.  The first is that we break into two groups now.  One of
which would be the Gulf Oil subgroup to continue that discussion.  And
then the other group would be specifically for the purpose of doing some
brainstorming about another subject that we might tackle in more detail.
That's option one.

		Option 2 is that we simply continue to have a discussion as an entire
committee for a while doing some brainstorming about which subject or
specific subjects we really ought to focus our attention on, in addition
to Gulf Oil.  So those are two different possibilities.

		MR. BUCHAN:  I prefer Option 2.

		CHAIRMAN SILVERSTEIN:  Which would be to continue as an entire group
to do some brainstorming based on all the input we've had earlier in the
day.  Would others agree with that?

		MS. SEMINARIO:  I do.  I think that as well as far as the Gulf group
maybe refocus a little bit since there have been so many changes and we
got so much information today.  I think you're correct there's
definitely some validity keeping it going, but maybe refocus and see
what the other team members think.

		CHAIRMAN SILVERSTEIN:  So that would mean we would stay as a group
here with two topics.  One would be general brainstorming.  My guess is
that other committees share with me the view that if we just continued
to discuss with the agency all the things that they're doing we'll never
reach any closure on anything and that we've got to pick.  And so the
first subject for us as a group would be to do some brainstorming with
an effort to make some decisions about where we would focus energies.

		And then the second topic would be helping the Gulf Oil workgroup
sharpen up the next stages of its work.  Does that work for everybody?

		MR. BUCHAN:  I would like to say something about the Gulf Oil group. 
I really think that we are behind the curve now.  When we met last time
there was a lot going on that we did not know about.

		Our briefing today made me feel very good about NACOSH, OSHA, EPA,
NIEAS, and the roles that they played.  And it's still continuing. 
There's still some cleanup and I agree with that.  But they are already
going though the process of lessons learned.  And I think that OSHA and
NIOSH are probably going to be in pretty good shape for whatever happens
next week that's a major disaster in this country.

		I volunteered to serve on the Gulf Oil Spill group.  And quite
frankly, I don't see that we have that much to do, considering what
NIOSH and OSHA have already done and are doing.

		CHAIRMAN SILVERSTEIN:  Okay, let's do this.  Let's take the first part
of the rest of the afternoon, the next half hour or so and talk
specifically about the Gulf Oil issue and then we'll do the more general
brainstorming.

		Thoughts about it?  Denise?

		MS. POUGET:  Just thoughts listening to the report, which I too
thought was really complete and there was a lot more going on than I
realized.

		But just in general, just so that all the lessons learned are getting
tied together, broaden the scope as to allow the lessons learned to
encompass all HAZMAT disaster, maybe perhaps not just necessarily the
Gulf oil spill.

		But one thing just from the fire department side, we have somewhat
boilerplate things that we ensure happen the minute something occurs, an
emergency occurs.  And I'm uncertain if that's the same thing because
OSHA went in there and did a lot, based on what they told us.  And maybe
all that was going on when we first met, but we didn't know that.  It
seemed a little hodgepodge from the information we were getting.  But I
would think that discussions on just in general are these lessons
learned like, for example, worker safety and health is number one.

		So what immediately happens as far as an analysis for protective
equipment, training for the individuals, organization information and
feedback for the individuals, rehabilitation for the individuals.  How
long did that take for that to happen so that if we have, for example,
another spill -- in general, you can look because there's chemical,
petroleum, so forth -- things that we should be doing immediately.  That
was my thought.

		We could make recommendations that immediately we ensure that worker
health and safety is number one.  And here are the things that we
strongly recommend that ensure are happening right off the bat.  I mean
I realize there's some assessment and so forth that takes place, but we
were kind of really unsure of what was going on last time we met, but
that was my thought.

		CHAIRMAN SILVERSTEIN:  We'll start this way.  Emory?

		MR. KNOWLES:  Emory Knowles.  Again, just a quick comment.  They're
going through the lessons learned.  I think we need to wait until we see
what comes out in terms of publications of the lessons learned.  That
will give the committee a much better idea whether or not we need to
recommend further movement, for example, towards a specific standard on
heat stress or what have you.  But I think we ought to at least give
them the opportunity to pull together the lessons learned.  I think
we'll see a lot of good from that.

		CHAIRMAN SILVERSTEIN:  Joe?

		MR. VAN HOUTEN:  Michael, the one area that still concerns me is the
issue of the 11 workers that died as part of the initial explosion. 
When I reflect on OSHA's report today that the 18 egregious cases that
they brought forward this is not one of them because they don't have
jurisdiction.

		I would like us to have some discussion around that and I'll leave it
to you to find out if this is a point of order or whether we can discuss
this.  But when I look at the safety of the American workforce, I think
that these 11 Americans should be discussed.

		I don't know if any of you saw this report that just came out.  It's
called Public Attitudes Towards and Experiences With Workplace Safety. 
It came out in the last month or so.  And Tom Smith who did this report
said that of all the public opinion polls that were done around the Gulf
oil spill none of them talked about the 11 workers that were killed. 
All of them talked about the environmental contamination.  I'd like to
bring that discussion back so that we talk about the initial event,
those 11 people who were killed and see what kind of recommendation we
can make going forward so that these lives are protected in the future.

		CHAIRMAN SILVERSTEIN:  Peg?

		MS. SEMINARIO:  Just to follow up on that, I mean OSHA will look at
lessons learned and hopefully do that in coordination with NIOSH.  But I
think John Howard in his opening remarks on this made a very good point,
which I tried to reiterate is that in this case I think the agencies did
a good job, but there is nothing in our planning mechanisms, planning
documents in oil or in any of the other planning that goes in the
organizational structures that puts worker safety and health first.

		I mean OSHA puts it first.  NIOSH puts it first.  And they yelled and
they screamed and they got at the table.  But if you look at the
apparatus that is set up in this country for responding to emergencies,
workers safety and health is an annex.  And it's up to somebody else,
the Coast Guard or somebody else, whoever is the lead to decide whether
or not they want to activate that annex and have worker safety and
health issues looked at.

		So I don't think that's an issue of lessons learned for OSHA and NOSH.
 I think that's a policy issue that needs to be address in looking at
this, and that this committee it would be a useful role to look at those
structures and what does it take and what should change to make worker
safety and health first?  Because as I said, in every one of these cases
worker safety issues are front and center.

		I mean 11 workers died up front and the exposures were workplace here.
 But that, on paper anyway, is a secondary element of the response and I
think that's something that needs to be addressed.

		CHAIRMAN SILVERSTEIN:  That's a good point.  I think jurisdiction is
part of that, but the entire question.  Bill?

		MR. BORWEGEN:  If you look at preliminary information, it would lead
you to believe that the safety culture among the workforce could have
resulted in this tragedy.  But I just have to agree.  This idea of this
nonmandatory appendix we need to elevate OSHA's stature for these future
responses.  I mean it's crazy that it's in again a nonmandatory
appendix.  So some how we need to elevate and codify OSHA's role in
whatever national response plans we have to deal with these types of
emergencies or catastrophes.  And I think that's a unique role that this
committee could play to publicize this in equity and that it needs to be
addressed.

		Peg wants to make health and safety first.  I just want to get it on
some kind of even kill.  I mean right now it's less essentially.

		CHAIRMAN SILVERSTEIN:  I appreciate the comments being made.  I agree
with them, but I'm trying to wrestle in my mind with how as a committee
that is advisory to these agencies we can actually make some headway in
these areas because it doesn't make sense to me, for example, that we
recommend to OSHA and NIOSH that they no longer be treated as an annex. 
So just help me think through what we can actually do that will have an
impact.  I'll come back around Peg.  Linda?

		MS. MURRAY:  From what I understand we're talking about, I guess I
want to strongly suggest we keep a subcommittee.  And it maybe that
we're not looking only at Gulf Oil, but I would argue that we should
expand the Gulf Oil workgroup to the protection of workers in emergency
response.  And I think we can make a series of recommendations for NOSH
and OSHA.

		I think you're right.  The real questions is not what lessons they
learned.  The real question is what lessons did Homeland Security and
the Coast Guard and the other people learn.  And I'm not confident that
they learned the right lessons.  But the advice to NOSH and OSHA could
easily be to work with the appropriate agencies, both in the mandatory
FEMA training that all public health people have to take as well as in
other setting at the federal level and filtering down to state and local
jurisdictions to give people the tools that allow them to do this.

		I  mean it's fine to say we should be first, but the reality is in
most emergency settings there's no one for hundreds of miles that have a
clue how to do that, how to protect workers.  I want to remind people
that haven't been to the FEMA training recently it's there.  I mean it's
supposed to be one of the mandatory things you're supposed to have as
somebody that pulls the trigger if health and safety of the emergency
response people are in danger.  How that gets operation-wise is
different.

		So I'm specifically suggesting that we broaden that workgroup's
charter to look at how can NOSH and OSHA, through training, policy, a
whole series of things make sure that the health and safety of workers
involved in an emergency is appropriately addressed.  And I do think
means policy changes as well as training and other kinds of stuff.

		CHAIRMAN SILVERSTEIN:  Sounds very helpful.

		MS. POUGET:  I actually totally agree with what Linda just said
because just from my perspective listening last time as an emergency
worker I'm pretty well prepared for this stuff and I'm listening to no
respirators, no this, no that.  And it seemed very fuzzy as to just
exactly what they were doing for these people.  And the one thing that
sticks out clearly in my mind is one day you're fishing for a living. 
The next day you're cleaning up hazardous materials for a living.  So
these people have absolutely no idea what they're getting into, none.

		So that's why I think that something like this would be very
beneficial, these recommendations.

		CHAIRMAN SILVERSTEIN:  Yes?

		MS. SHORTALL:  Can I ask a question of Ms. Murray?

		When you said the word 'emergency,' did you mean to include the
clean-up after emergency has ended?

		MS. MURRAY:  All of it.  It has to be all of it.

		MS. SHORTALL:  Okay.

		MS. MURRAY:  And if you go through the training and manage to stay
away, which is a big challenge, the FEMA training is very clear that
you're supposed to have somebody there.  And they're very clear that it
includes pass the acute period.  That you have to be able to shut down
the entire incident.  So all of that is included.  And in something like
the Gulf Oil that may very well be nine months, a year out.

		And again, we should see NIOSH and OSHA as repositories of expertise
that is in scarce supply in our country.  So the ability to figure out
how to spread that expertise and how to be technical consultants and a
whole range of other kinds of tasks seems to me to be appropriate.

		MS. SHORTALL:  I guess the reason I ask that question is some of the
documents that the Department of Homeland Security and other agencies
have developed regarding various types of emergency situations such as
dirty bombs or biological things some of them divide the tasks very
distinctly into that which would be considered emergency response and
that which would be considered clean-up after an emergency has ended. 
That's why I wanted to inquire.

		MS. MURRAY:  But don't forget we're talking about the impact on
workers.  So workers are there during all those time periods.  And I
want to be also clear that's why I asked what I did about local
governmental workers, okay.  So even workers that are  not technically
in the jurisdiction of OSHA, for example, we need to provide tools for
that.

		Let me make one concrete suggestion because I'm not on that workgroup.
 And maybe one of the things they ought to do is force BP out of the
money that they owe us, owe the government, all the different levels of
government to set up a special fund or something that can actually fund
some research and some direction in this area.  What do we do about
protecting workers, especially people that aren't normally emergency
responders?  The responders we get a bunch of training, but then we
always have people involved that don't have that level of training and
are coming in totally blind and unknown.

		CHAIRMAN SILVERSTEIN:  Anybody else?  Peg?

		MS. SEMINARIO:  One of the other issues that needs to be looked at,
which still isn't clear to me after spending a lot of time, including a
series of weekly calls we ended up having with OSHA and NIOSH on the
Gulf Coast clean-up and worker protection issues is the whole issue of
training for those individuals.  And I think it came up as an issue. 
Decisions were made early on about limiting the amount of training that
was required and not applying the requirements of the HAZWOPER standard.
 Never sort of clarity as to why that was other than that's what had
happened at Exxon Valdez.

		But clearly there was not the apparatus in place, either
institutionally or with respect to the workforce there to respond to
this incident in so many ways.  And one of those ways was making sure
that people had training and what that was and what kind of training was
really needed.  I think actually looking at that in a further analysis
and evaluation, not just lessons learned but some evaluation as to
whether what was done was adequate or not is something that could
happen.  And that the training piece of it is really critical and having
in place beforehand a sense of what kind of training is appropriate. 
Because this is one area where there actually are some standards that do
apply.

		CHAIRMAN SILVERSTEIN:  The jurisdictional issues are interesting.  I
carry around in my briefcase like a 7- or 8-page document that goes
through all kinds of scenarios.  If there's been a problem on Tribal
land and the employer is the Tribal employer whose jurisdiction is it? 
What if it's Tribal land and it's a non-Tribal employer?  And then what
if it's an inland waterway that's navigable?  How about an inland
waterway that's not navigable?  What about if it's a railroad?  What
about if it's an airplane in the air?  It gets very complicated and I
think the Gulf Oil situation it put a spotlight on how fractured the
systems are and how OSHA and NIOSH are often peripheral or become
peripheral.

		MR. BORWEGEN:  I was going to offer a suggestion.  It might be
simplistic and not feasible, but if we are advisory to I think the
Secretaries of Labor and Health and Human Services, is it outside of our
bounds to say that -- because I don't know what agency was responsible
for safety out on that rig.  I don't know.

		But agency X is responsible for safety that because OSHA is a
recognized expert when it comes to occupational safety and health, they
must review whatever plans that agency has in place regarding on-site
inspections to make sure that they give the imprimatur to that plan on
behalf of that agency.

		So to set up OSHA as the lead agency for all federal agencies to
review issues of occupational safety and health.

		CHAIRMAN SILVERSTEIN:  Statutorily, it's going to be hard.  I mean
think about it.  All the state employees that work in Louisiana and
Florida they're not even covered by OSHA statutorily, right.

		MR. BORWEGEN:  But who's responsible for the safety on that rig?

		MS. SHORTALL:  MMS.

		MR. GOODARD:  The Coast Guard because that's a vessel.  Because it's a
vessel.  It's a semi-submersible vessel.

		CHAIRMAN SILVERSTEIN:  Both are federal agencies.

		MR. GOODARD:  It's not attached to the floor.  It's semi-submersible,
so it's a Coast Guard ship vessel.  So they have an inspection program
for that vessel.  But they don't have anything to do with the drilling
operation aspect of it where MMS comes in and does their inspection and
gave that rig a stamp of approval.  So they have their own
jurisdictional issues based on if it's attached to the sea floor, which
the Deep Water Horizon was not.  We have issues beyond three miles from
the shoreline, jurisdictional issues, and then there's MMS that comes in
and looks at the actual operation and the flow preventer and the
mechanics of the drilling operation itself.  So fractured is not a bad
word, Mike.  Jurisdictionally, it is fractured.

		MR. BORWEGEN:  But even when OSHA could have jurisdiction they're like
tucked away in the annex, right?  I mean it's just like when you could
have jurisdiction they should have more robust roles really I think is
the best we could hope for, and maybe we could hope for more.  I don't
know.

		CHAIRMAN SILVERSTEIN:  I think the observation that characterizes the
problem that I think we're beginning to focus in on is the observation
that the 11 deaths from Deep Water Horizon have faded from public
concern very quickly compared to everything else that was going on.  And
so I think that Linda's suggestion that the charter for this group be
expanded to address a number of the issues having to do with getting
more attention paid to the protection of workers during these kinds of
horrible events may make some sense.

		Let's see what people think of that suggestion.

		MR. GOODARD:  May I make a suggestion?

		CHAIRMAN SILVERSTEIN:  Absolutely.

		MR. GOODARD:  A lot of this discussion has been had during hearings. 
We have testimony.  We have expert documentation of people who testified
in these hearings.  I have access to that.  If I could inform the
committee before you lock into -- like if chose jurisdictional or you
chose some other statutory issue, that's been hashed out by real
experts.  John Howard has testified.  David Michaels has testified.  I
wouldn't mind pulling some of that together to help you make the
decision about what you do as next steps.

		You know BP just did there investigation.  There are five other
Presidential investigative committees, DHS committees that are due and
pending on findings on the whole incident.  I don't think the 11 workers
have been ignored yet by those investigatory panels.  It's coming down
the pipeline.  I'm offering to get the testimony and get some expert
information to help you make your decisions about where you go with your
subcommittee.

		CHAIRMAN SILVERSTEIN:  I appreciate the offer and I think we will
probably want to take you up on it.  But right now the proposal that
Linda made was fairly general.  Namely, that we should broaden the
charter of the workgroup to address the protection of workers in
emergency response situation.

		Now what I want to see is if there's some agreement at that general
level that we ought to be moving in that direction?  If that's the case,
then we can talk about how we narrow in and focus in and make it more
specific.  But we need more discussion about what Linda proposed.  Peg?

		MS. SEMINARIO:  I think it's an important area, but I think we should
have a discussion about some of the other issues that out there.  The
committee can only have so many workgroups to look at whether or not
that warrants a workgroup or is there something in this other area. 
It's not just one or the other.  Do you see what I'm saying?  I think
that if we're going to be broadening things out before making a decision
to do that that I would say let's have the discussion about what are the
areas where we want to be looking at and working because there may be
others that are looking at that would rank, at least in my mind, higher
for a workgroup's time.

		CHAIRMAN SILVERSTEIN:  Okay.

		MS. SEMINARIO:  Because I see that looking at this whole issue of
emergency response as taking more time.  Whereas, I would see looking at
some of the Gulf Coast issues, perhaps a shorter period of time to
finish that work and that's why we look at them very differently.

		CHAIRMAN SILVERSTEIN:  Okay.  Bill?

		MR. BORWEGEN:  And if you look at it even in a broader scale, and I
don't know where this takes us, but I'm going to throw it out.  I mean
Peter's point earlier about not disciplining workers dealing with near
misses and near hits I mean the bottom line is if we had a policy in
this country were workers were incentivized to report near hits or near
misses, perhaps we could have prevented this from happening in the first
place.

		And so I just need to raise that because not only should we be talking
about how do you respond to emergency, but how do you prevent
emergencies.  And I think it's tied directly into the Injury and Illness
Prevention Plan.  I mean and that's why it's so critical that, again, we
remember these 11 workers, but also this could example of why we need a
strong Injury and Illness Prevention Plan, even if it doesn't cover
these workers because they're outside the jurisdiction.  But it does
speak to the issue of OSHA and prevention, which is primarily what the
agency is about in that response.  Maybe that's too much to grapple
with, but I think a case can be made that it's all interrelated and it's
a way to remember the 11 workers who died that everybody seems to have
forgotten and how this tragedy could have been prevented if we had a
system that incentivized near miss reporting.

		CHAIRMAN SILVERSTEIN:  We're drifting into the lumpers versus
splitters debate.  And I think we can continue that for a while, but
then we're going to have to short circuit it and make some decisions.

		Other thoughts about where we should focus energy?

		With regard to the Gulf Oil situation there are I think three
possibilities here.  One is that we decide that we will drop this
workgroup.  That it's done all you could do and there are other things
that we want to turn our attention to.  That's one possibility.

		The second is that we continue it, but we actually broaden its scope
in the way that Linda suggested.  And the third possibility is we
continue the group, but we really narrow its scope to something that
would be more manageable in a shorter term.  Three very different
possibilities and I've got to get a sense of where people's inclinations
take them.  Joe?

		MR. VAN HOUTEN:  Michael, I just had a thought about if we decide to
continue the subgroup I think the logical next step is to review the
lessons learned that OSHA's putting together now and then maybe evaluate
is there anything more that we need to do once we digest all of the
lessons learned that OSHA has already put together.  So we might
continue the group, pending what we get out of the lessons learned.

		CHAIRMAN SILVERSTEIN:  That's a possibility.  Denise?

		MS. POUGET:  Is it also possible to be maybe a little bit more
aggressive and come up with perhaps an outline of areas that we know we
want to ensure were covered and discuss where that path takes us. 
That's just another thought.

		CHAIRMAN SILVERSTEIN:  Peg you're nodding at that?

		MS. SEMINARIO:  One of the things that we did at the last meeting was
it was in the middle of the response and we made some recommendations,
which I think really helped focus the agency in their activities.  I
don't think that was just platitudes.  From all the discussions we had
following that it really helped them frame in their minds some of what
they needed to do to get their hands around the exposures, coming up
with matrices, coming up with the recommendations, et cetera.

		We might want to have some discussion now about in thinking about
their lessons learned if they're going to be coming out with a document
or an evaluation what are things that we think they should be talking
about and raising in that rather than reacting to it after the fact they
come back pulled together here.

		And I think that that might be a useful expenditure of time today or
tomorrow because I can think of things based upon what we heard today
and what we know that I would ask them to consider and talk about from a
different perspective that the agency might have, having been in the
middle all of this.

		CHAIRMAN SILVERSTEIN:  You have an example in mind?

		MS. SEMINARIO:  Yes, I think that the agency's view from all the
discussion is that in the area of training that it was okay, right?  And
I think that it's something that to do an evaluation did people actually
have the training they needed when they needed it, right?  I'm not sure
that they did.  But I would ask them to look at those issues.

		I think that because Dr. Michaels and others here were very aggressive
they were able to force the worker safety issues forward.  But did the
overall plan that was set up here really provide for worker safety to
have the prominence that it needed in this response?  There's a
difference between just the lessons learned in terms of what happened in
this case.

		But again, if you want to apply this in the future, that's got to be
looking somewhat to a system's approach, not just what did the force,
the dedication, and personalities were able to pull off here.  So I
would ask them to look at some of the systems issues in addition to just
the execution and the force of will and targeting of resources because
that's where I think the problems are.

		And it was said earlier, there are models.  There are template that
exist in other areas.  You know what you're going to do. If this happens
again, there is no template.  It's the next administration.  It's
somebody else that's here.  And so I think those are some of the things
that we should ask them to look at as part of the lessons learned and
their evaluation as they are looking at it now.

		CHAIRMAN SILVERSTEIN:  Do I understand correctly what you're
suggesting is that we could by the end of the meeting tomorrow we could
provide a document to the agencies that says we know that you are
working on lessons learned.  We believe that whatever that document is
should include at least attention to the following three things.  Is
that sort of the --

		MS. SEMINARIO:  Yes, that's right.  Attention on these issues here and
the view of the agency as to what worked.  What didn't work.  What would
be helpful to change in the future to make the job easier for the next
time, the next administration so that it actually has some -- in going
forward.

		I think what we tried to bring as a labor community who was involved
in the Exxon Valdez and the 911 was our lessons learned.  Because even
though the agency some people had been through it, Dr. Michaels hadn't
been.  Debbie Berkowitz hadn't been.  Others hadn't been.  So to figure
out how do you basically institutionalize that approach so the next time
you don't start from scratch.

		MR. GOODARD:  Mike, just a quick comment.

		CHAIRMAN SILVERSTEIN:  Go ahead.

		MR. GOODARD:  I will use an example.  I have a sense that the lessons
learned could be reinternalized of an operational approach in terms of
who you brought in two weeks on, two weeks off.  We had people working
overtimes.  Our own staff working long hours.  So it could be proactive
to help the agency instead of waiting until we were done.  The lessons
learned could be how we managed our own internal resources to address
the spill.  That will come up at the RA level.  The RA officers how they
dedicated their staff without ignoring their real job and their regions
and how you get people to volunteer from different regions.  That was
quite challenging.  It's always challenging when we have a disaster.  So
a broader perspective could be useful for future.

		CHAIRMAN SILVERSTEIN:  I don't hear any clear consensus emerging right
now.  There are a number of different possibilities that are on the
table.  I don't hear anybody suggesting that we should drop this area
completely.  But Peg did urge us that before we make a decision that we
see what else is on the table because I imagine if we had a discussion
about the other issues that we might want to focus on it may be that two
or three things emerge that would knock this off the table.

		MS. SEMINARIO:  Right.

		CHAIRMAN SILVERSTEIN:  So let's set that aside for right now and open
up the discussion a little bit more broadly to the whole range of things
that have been coming into us.  I'd like to know what people have picked
out as seeming particularly important that this committee may play a
useful role in.  Peter?

		MR. VAN HOUTEN:  Even before we do that, I guess some clarification
about how this committee structure is going to work or how we envision
it.  Because when we left last time we had this notion that the
committee was going to be functioning in between the meetings.  And I
don't know enough about the process to know -- I know there are some
restraints in terms of -- to have that clear.

		CHAIRMAN SILVERSTEIN:  I'll take responsibility for that.  I am
learning about what can and can't be done as we're going along here. 
And one of the things that I learned pretty quickly is that for the
process to continue on an ongoing basis requires much more active
management on my part and the part of some others than we put into the
interim, this first time around.

		One of the things I want to do before the end of tomorrow is to have a
serious discussion about what happens in the interim before the next
meeting.  So whatever we decide to focus on we have to make plans for,
or else it'll just disappear until the next quarterly meeting or
whatever.  Emory?

		MR. KNOWLES:  A novel thought.  Does OSHA have its own internal
national response and contingency plan?  OSHA's been through the World
Trade Center.  OSHA's now been through this.  As companies, we put the
other contingencies plans covering everything from biological attack to
a gas line explosion.  I mean why can't OSHA come up with a national
response plan for the agency which essentially outlines in a matrix form
all the things that they would need to implement and do?

		MR. GOODARD:  We become part of the Coast Guard and FEMA when FEMA
came into Katrina.  We become part of the national response plan.  So
usually the lead agency like the Coast Guard in this instance.

		MR. KNOWLES:  I'm just thinking about the training issue because this
report, which I stuck back in here and I can't find now, talked about
the training.  It talked about HAZWOPER and the time period required for
the HAZWOPER training, yet only eight hours was done because there was
probably a letter of interpretation that was in the file somewhere that
BP jumped on, so they only did the eight hours.

		But if the agency went out and developed a total, comprehensive
training plan for chemical emergencies, explosive incidents, terrorist
incidents the outline would be there on what needed to be done.  Just a
thought.

		MR. GOODARD:  By the way, they didn't do eight hours in most cases,
four or less.

		MR. BORWEGEN:  Which might have been enough for cleaning up tar balls.
 Who knows.  I mean the experts would be like Chip Hughes from NIH could
tell us because there was a constant back and forth on what BP thinks is
adequate versus what NIOSH, which was really the premiere worker
training agency in the country felt was sufficient.

		MS. SHORTALL:  OSHA has, just like every agency in the government, a
requirement to have a continuation of operations plan.  So if something
major were to happen the agency would be able to continue to function. 
All agencies have that.  That's federal government requirement.

		When it comes to a specific type of hazard, it does determine what
agency has the lead to it.  For example, anything that would be
considered a terrorist activity the lead for that is Department of
Homeland Security and they have been developing all kinds of plans. 
OSHA does participate to certain degrees in those and does review
documents concerning those.

		CHAIRMAN SILVERSTEIN:  I see a hand up from the audience.  Could you
identify yourself.

		MR. HEARL:  Hi, this is Frank Hearl.

		CHAIRMAN SILVERSTEIN:  I didn't recognize you, Frank, for a second.

		MS. POUGET:  Could you identify what agency you're from?

		MR. HEARL:  Yes, I'm with NIOSH.  And I was going to say that I think
the general framework that I think you're asking for is actually in the
annex to the ESF8, that is the Worker Safety and Health Annex spells out
the general framework as to how OSHA and NIOSH built in through that
would work with those other agencies in response planning.  And that's a
very generic plan.  It isn't a specific thing like how are we going to
react to a hurricane or how are we're going to react to the oil spill. 
But it does spell out the basic interactions that we have with the other
federal agencies that are a part of that technical plan.

		Of course, in response to this particular oil spill, it actually never
activate the overall response plan anyway.  It was kept at a different
level.  I wanted to throw that in there.  We do have that for the Safety
and Health Act.  You probably ought to take a look at that.

		CHAIRMAN SILVERSTEIN:  Thank you.

		Let me suggest something here.  I've been writing down a list of other
things that various folks have suggested ought to occupy a lot of
attention of this committee.  Let me share that list and see if this is
helpful in beginning to charter a direction that goes either beyond or
in addition to Gulf Oil concerns.

		Number one, John Howard suggested this morning, and some other people
agreed that we should be paying attention to or helping the agencies
think through the working relationship between OSHA and NIOSH.  Specific
concern about the relationship in rulemaking was mentioned, but I think
the concern was even broader than that.

		A couple of people have suggested that we spend time helping OSHA in
its efforts to figure out what to do with the permissible exposure
limits.  There have been a few people that have sent me emails or called
me to suggest things that NACOSH may do.  So I actually had a suggestion
from the outside that we ought to be helping the agency to figure out
what to do with the PELs.

		Melissa McDermott, who some of you know is an expert in the area of
the dangers of chemotherapy agents and other hazardous drugs has
suggested that this committee might spend some time helping the agencies
figure out what to do about the dangers of therapeutic agents.

		Joel Ticker from the University of Lowell has suggested that OSHA and
NIOSH ought to be working on strategies for safer chemicals,
substitution strategies.  The OSPA, the Organization of the OSHA State
Plans has suggested that the OSHA rulemaking process is broken and ought
to be revisited.

		And I would point out that several years ago I think when Peg was on
this committee in the former life of the committee there was actually a
fairly long advisory document that was created that suggested to the
agencies how rulemaking could be streamlined and that document still
sits without action, I think.  The state plans have also suggested that
we pay attention to helping OSHA strengthen the relationship it has with
the state plans.

		Roy Buchan has suggested on a number of occasions -- I haven't
forgotten this Roy -- that OSHA and NIOSH do not pay a lot of attention
to agricultural safety and health.  Now John Howard did not the regional
safety and health research centers, the AG centers is one thing that
they are doing.  But I think you pointed out that especially within the
context of OSHA that there's very little attention being paid to AG.

		MR. BUCHAN:  It's not all OSHA's fault.

		CHAIRMAN SILVERSTEIN:  What?

		MR. BUCHAN:  It's not all OSHA's fault.

		CHAIRMAN SILVERSTEIN:  Right.  I think you have mentioned
congressional riders and the like.  I think that Susan you raised
earlier the need to pay more attention to workplace violence issues.

		Bill Borwegen on a number of occasions has raised a variety of
concerns about the safety and health risks experienced by healthcare
workers were the injury and illness rates are particularly high and the
number of employees is greater than in most of the segment that OSHA
pays its most attention to.

		MR. BORWEGEN:  The bigger question really is the prioritization of
OSHA's limited resources guided by BOS data.

		CHAIRMAN SILVERSTEIN:  That was the next thing I was going to get to.

		MR. BORWEGEN:  I'm sorry.  Go ahead.

		CHAIRMAN SILVERSTEIN:  A number of people have come at that in a
variety of ways.  The issue here would be talking a look at where OSHA
and NIOSH's resources and attention currently exist and how that matches
with some indicators of where the need is.  Are the agencies paying
attention to where the areas of greatest need or are they locked into
some other pattern that is not the most productive?

		Of course, influenza we discussed earlier.  A number of the committee
members as well as John Howard suggested we pay more attention to that.

		That's the shopping list, the stuff that I've been writing down.  I'm
sure there are other things.

		UNIDENTIFIED MALE:  What was the context of influenza?  Was that
around protecting healthcare workers?

		MR. BORWEGEN:  The fact that H1N1 is a working age disease.  It's not
the typical seasonal influenza that primarily kills people over 65 an
that we have protections on the books right now that CDC has and they're
getting ready to basically gut them, which is contrary to what the IOM
has found that the lowest form of protection should be when a patient is
coughing in your face should be a fixed N95 respirator.

		CHAIRMAN SILVERSTEIN:  If we decided that as a committee, every
meeting we were going to spend a little bit of time on each one of these
we would not be playing a useful role.  So we've got to start to
articulate the things that are most important, knock some things off the
list for later.

		And in the process, I don't know as we do that if Gulf Oil stays on
the list or gets knocked off.  But I think now is the time we have to
start thinking seriously about where we're going to devote attention.

		I think there will be some new members to the committee at the next
meeting.  I'm not sure how many.  I don't know where OSHA is in the
process.  There were nominations made and there is going to be some turn
over.  But as of the next meeting, we will have a committee in place
that is going to be stable for a couple of years.  So this is the time
when we really have to decide what that committee is really going to
concentrate on.

		At any rate, where do people think we ought to go from here?

		MR. BUCHAN:  You missed one thing that was talked about today, and
there really hasn't been any discussion of this.  But to me it's the
very essence of what OSHA should be doing and that's their new program
on injury and illness prevention.  And I really don't know what was
really involved, but we did get a briefing on it.

		CHAIRMAN SILVERSTEIN:  Yes, and we will hear more from Dr. Michaels
tomorrow.  I remember at the first meeting when Dr. Michaels told us
about the importance he feels is due to the injury/illness prevention
rulemaking.  I got kind of a mixed message from him about whether or not
he thought that there was enough going on so that we didn't need to add
to that or if he really wanted our assistance on it.  I'll get a bit
more clarity tomorrow.  But it clearly is an important area that we
could contribute to.  Bill?

		MR. BORWEGEN:  I mean on the influenza it's just an example of another
thing that OSHA's working on, which is their infectious disease rule
that they're  looking at, above and beyond what they're already have for
blood borne.  This would cover airborne and contact transmission.  And
again, they're just at the information collection stages for that, but
it's all kind of linked together with the need for a comprehensive
infectious control protections.  So not just for healthcare workers but
for all workers.

		CHAIRMAN SILVERSTEIN:  Let me share with you one of the things out of
all this long list that jumps out at me that I keep coming back to.  And
in part, this is from an experience that I've been having at the state
level where we have an advisory committee to my agency.  And we've asked
-- 'we,' meaning the state OSHA program has asked our advisory
committee, the equivalent of NACOSH to help us to make some decisions
about priorities.  And we've asked that committee to look at where we're
putting our energy and match that against were the needs are.

		So we gathered a bunch of information on injuries and illnesses, both
the numbers of injuries and illnesses.  This is worker comp data, so
it's claims data.  So we provided the committee with a lot of
information on industries where there were a lot of claims by number and
also a high claims rate.  And we combined those two in an index and then
came up with the top 10 by three-digit and four-digit NAICS code.

		And then what we did is we looked at those industries.  Once we had
them arrayed by the injury and illness experience, we looked at what we
were doing in those industries.  And one of the things that popped out
immediately was that if you compared some of the building trades with
healthcare you could readily see that the injuries and illnesses and the
claims costs were roughly equivalent.  But we were putting almost all of
energy with regard to inspections and consultation visits and technical
assistance into construction and almost nothing into healthcare.

		And so this is now a mismatch that we hope that our advisory committee
is going to address in some way.  I don't know where that discussion is
going, but it seems to me that we could be doing something similar in
advising OSHA and NIOSH about whether or not they're putting their
energy in the right or the wrong place.  So that one, to me, just keeps
on surfacing as an area where we might be able to be really useful in
the relative short term.  Peg?

		MS. SEMINARIO:  I that's a good idea, particularly since looking
forward here I don't see that there's going to be a lot of new
investments going on in safety and health as far as the federal budget
in any agencies.  And so trying to figure out and determine how best to
deploy and then utilize the resources I think is really important.

And so I do think that that exercise is a good idea because the other
thing that it does is that it brings some public attention to what are
some of the major issues and some overall sense of what are the big
problems that exist and what kind of resources are being devoted or need
to be devoted to them.

		And I think that would help the agencies, but also provide some level
of information to the public, quite frankly, as to what kind of
resources are really devoted to these different issues.  And when you
lift up the curtain, it's frightening as to how limited the resources
are that are devoted to a whole host of problems that have grown over
the years.

		And this is something that we at the AFL-CIO do regularly.  We do a
report, which I'm happy to share with people that look at a lot of these
issues in some detail.  And what you see over time the resources have
diminished in terms of just not only the fact that the workforce has
grown, but the actual  numbers of people on staff at OSHA I think 600
fewer than it was in 1980.  And so those things are real and have real
impacts, and so I think it would be helpful.

		And one area that I would think we want to focus on here that hasn't
gotten really much attention, and it comes up in a number of these
different discussions, whether it's on permissible exposure limits,
illness and injury prevention, a lot of the focus is on injuries.  And I
think have a discussion around the health side and the exposure side is
really important.

		A lot more attention was paid to health  issues, health standards,
toxic chemical exposures in some of the earlier decades and the agency
needs to get back into that arena.  And I'm not saying only in
standards, but in some other ways and the whole area of health
targeting, health inspections.  I mean this is a huge area and so I
would think that helping the agency think through what are the different
initiatives in the area, looking at occupational health programs,
particularly also NIOSH has a very important role to play in that area.

		And I don't think that thinking about that or the deployment of
resources, particularly in the health area has really gotten almost any
attention in any thoughtful -- certainly not in any comprehensive way in
a very, very long time.  And so I would propose that that be a piece of
this.  That is a really important area to look at.

		MR. GOODARD:  Mike, if I could just mention two items.  This is all
interesting because OMB is going to approve the department's strategic
plan pretty soon, beginning the fiscal year October 1, which is on us. 
That's been through clearance and the list of very detailed strategic
approaches based on the secretaries' goals for their own department, so
OSHA's in there.

		And coming right behind that same week would be OSHA's annual
operational plan, which I think you have to see to have this
conversation that we're having because it gets into some of the
initiatives that Richard's been working on in Enforcement, I think the
focus on health inspections for just as an example.  And we have the
regulatory agenda.  The gallies are due back anytime soon that sort of
prioritizes the agency's regulatory activity for the fall.

		So these are three -- then we have something called productivity
measures which would see that goes to a final level of detail in terms
of we're doing with NEPs and which ones we're looking at and where we're
focused.  I just want to make you aware of these things that are
happening eminently that you have to see to have these conversations
because they're going to go public.  They'll be on the website and
they'll be public.

		MS. SEMINARIO:  And if I can comment as somebody who's been on NACOSH
for over different decades here, back in the nineties when there was a
lot of work going on around strategic planning, IPRA and all that,
NACOSH spent a lot of time working with the agency in reviewing the
strategic plan, giving guidance on the strategic plan, looking at the
performance measurements.  I mean that was the level of activity the
committee got into at the time that those were under development, not
commenting on them after the fact.

		And I think that's one of the things that we have to think about
there, given where things are we don't want to hold the agency up or
make them wait for us to get up-to-speed.  So where can we best put our
time and energy to help them going forward in helping things move that
would be useful and productive?

		MS. BUCHAN:  Peg, I agree with you.  But I think Michael is having
some real difficulty right now.  We have had an open discussion, which
is very worthwhile and it's important.  But Michael was hoping that
today we would find one or two areas where we would begin working. 
After all this discussion, and I think I've agreed with everybody at the
table, I feel somewhat inadequate.  I don't know what direction we
should be going.

		CHAIRMAN SILVERSTEIN:  Let me just say two things.  First of all, I'm
flexible.  And secondly, I've been through enough of these meetings to
understand that there is a process and there's a period during -- this
is one of the reasons why you have two-day meetings instead of one-day
meetings because ideas have to peculate and you've got to wrestle with
them and there's a period of frustration in which you don't know which
direction you're going.

		And eventually, a group like this will provide some focus and we'll
reach some decisions and they'll be good decisions and we'll know where
to go next.  We're not there yet, but we're getting there.

		MS. MURRAY:  The thing I'm interested in is can we define -- I'm not
so much interested in a process where we pick out from this list of
interesting topics a small number of manageable topics.  Obviously, we
can't talk about all of them.  I don't have an answer yet, but I'm
interested in a way to think about systemic problems that may out of
which three or four of five of these topics may fit.

		So for example, as I've mentioned already with the Gulf Oil, to me
that should expand into what do we do about protecting the workers
during emergencies, which really doesn't have to say anything else about
the Gulf Oil situation.

		And I suspect there are other issues there, whether it's things like
infectious disease standard and how do we approach it?  How do we do
standard setting, not one at a time.  So to me, we should be talking of
ways to talk about and think about issues that will help these two
agencies.  I'm confident that if we thought about it more broadly
working with the agencies they'll be examples of either good examples,
bad examples.  Here's an area where we think we're doing it well. 
Here's an area where we're frustrated.  So that's the first comment.

		The second comment I want to make is that as you've mentioned -- I'm
been on a lot of these committees too.  I'm not particularly interested
in coming and hearing show and tell stuff, even though it's always
interesting.  But that's not really why I want to travel to D.C.

		And so if we agreed -- let me just say this as an example, just for
the sake of being concrete.  If we agreed that we were going to spend a
significant portion of our next meeting looking at the issue of how do
we ensure that the protection of workers is addressed appropriately
during emergency response situations and how NOSH and OSHA could move
that topic forward, if we knew that ahead of time, then I would expect
to see before the next meeting a bunch of documentation.  Certainly,
most of the presentation that would be made.  So that would cut some
time right there because I could read them ahead of time and they could
be made shorter.

		The lessons learned from the Gulf or whatever we could have a bunch
background materials and spend more time in discussion with agency staff
about approaches to these kinds of issues.  So if we thought going
forward about the agenda and think we have to always be flexible.  Stuff
is always going to come up.  The agencies are going to have specific
things that they may want us to look at and comment on.  That's okay.

		But if this committee drove at least half the agency with these are
the strategic directions we want to look into.  We haven't quite pushed
that out yet, but two or three strategic directions that we want to
think about and then working with the agencies to put the details of how
we would have those discussions.  That's the kind of thing I would look
forward to.

		CHAIRMAN SILVERSTEIN:  Susan?

		MS. RANDOLPH:  I'm hearing a lot of things today it seems as if most
of the agency's response has been reactive to a situation versus being
proactive and how you can learn from that and put preventive measures in
place and how can you move the agencies forward.

		We've heard some things with the Gulf Oil about the issue of heat
stress, yet there's not a heat standard.  To me, there's a real need. 
And we talked about the PELs, which are inadequate and how can you move
that forward, which when you think about the rulemaking process that's
their way to streamline that.  And from what Peggy was saying I guess
some document was prepared and is sitting on the shelf, or maybe you had
said that Michael.

		CHAIRMAN SILVERSTEIN:  I said that.  Yes.

		MS. RANDOLPH:  As to how can we look at that process that would be
something that would help the agencies so that they can move forward
because there is always going to be certain things that come up.  And a
lot of the things that are on the laundry list that deal with healthcare
workers, that deal with rulemaking process, that deal with injury and
illness prevention.  So I don't know if there is some way that we can
focus our efforts as going to move things forward, whether streamlining
processes.  I mean if the agencies are working well together now, at
least it sounds that way is there a way that that continue in the future
when agencies change directors and so on.

		CHAIRMAN SILVERSTEIN:  Bill?

		MR. BORWEGEN:  Again, it comes down to allocation of the agencies'
limited resources.  And so dependent upon what we agree on are
priorities that need attention based again review of the BLS data and
this inability to rulemake in a timely fashion that's the big question
of how do we allocate these limited resources in a way to effectuate
these changes?

		CHAIRMAN SILVERSTEIN:  I've heard two ideas that there seems to be
some interest in.  And let me see if I can articulate these in a useful
way and then see if there are really other competing ideas.

		One would be putting together a group that would provide some advice
on how can the agencies best match their resources with some assessment
of needs.  It's a deployment of resources issue or a strategic planning
issue.  I think there are several ways we could go about an exercise
like that, but that would be the basic formulation.  How can the
agencies best match resources with needs and are they doing a good job
of it now?

		And then the second is how can the agencies better ensure or what can
the agencies do to better ensure that worker protection get real primary
attention during periods of national need or during crises or during
emergencies?  Articulating these in that way, do either of those or both
catch people's attention or do we move on to something else, or are
there some other ideas that seem equally attractive?

		MR. BUCHAN:  Did I not hear that OSHA is coming up with a new
strategic plan?

		CHAIRMAN SILVERSTEIN:  Yes, OSHA is always going to be working on a
strategic plan and performance documents and regulatory agendas.  And
we're always going to be dipping into the middle of it.  And to the
extent that we can get in on some of these discussions early rather than
late, that's great.  But we don't control the calendar.  We are where we
are.

		MR. BUCHAN:  Yes. Okay.

		MS. RANDOLPH:  I would support those two areas because they're broad
enough and will provide some direction to both agencies.

		CHAIRMAN SILVERSTEIN:  I guess the question I would pose to you is are
those compelling enough so that they're worth people going back and
thinking about tonight to continue a discussion in the first hour of the
meeting tomorrow morning?

		MS. MURRAY:  I think we should leave open the possibility that people
may think of another similarly structured --

		CHAIRMAN SILVERSTEIN:  Absolutely.  And I'm open to that right now if
people have another possibility.

		MR. GOODARD:  I think David Michaels is going to have quite a bit to
share with you too that you may want to hear.  So leave that possibility
open.

		CHAIRMAN SILVERSTEIN:  Absolutely.  Bill?

		MR. BORWEGEN:  And I'm still struggling with this idea that I just
can't get it out of my head that this whole Deep Water Horizon thing
could have been prevented if workers felt free to report near misses and
near hits.  And I'm just wondering if there's a way to build that into
the second one or maybe that's totally separate.  But again, to me it's
like to prevent and respond to emergencies.  So to me, the prevention
part is if we can create a safety -- change the safety culture so that
workers can feel free to -- if there's an incentive to report near
misses and not penalized for that.  I don't know.  Maybe that's too
broad for the second topic and if so, that I certainly can defer to
people on that.

		CHAIRMAN SILVERSTEIN:  Go ahead Peg.

		MS. SEMINARIO;  One particular program that we haven't talked about at
all in the last couple meetings, which is a program that has grown
topsy-nervy in the agency is the Whistle Blower Protection Program,
which is not only 11(C), but 16 other statutes that OSHA is responsible
for implementing.  And it is something in the area of worker rights and
the right to speak out, raise concerns without fear of retaliation. 
That's where the legal protections are based.

		And there is discussion going on now within the agency.  There's
evaluation going on.  Not only within the agency, but the department.  I
mean OSHA is responsible for implementing the anti-discrimination
provisions of Sarbanes-Oxley, right, which has nothing to do with safety
and health, but it's an area that I think to think about here in the
area of worker rights and what exists currently in the area of not only
the legal protections, but the initiatives and programs that are in
place to ensure those I think is something that is worth some
exploration at some point.  So I would just put that forward as
something concrete that is then related back to the whole issue of
workers have an right to speak out.  And it came out not only at Deep
Water Horizon.  I don't think there really is a Whistle Blower Program
that exists over at MMS.  There's legislation to put in place
protections which then would come to the Department of Labor and OSHA to
implement.  But also a sister agency, MSHA, with the upper big branch,
people being afraid to raise concerns.  And again, not just the 11(C)
Program, but I'm talking about Injury and Illness Program.  What is the
piece of that which basically is written in a way that ensures peoples
ability to raise these concerns and to bring them forward early on.  So
I think it is something that's worth talking about and discussing.

		CHAIRMAN SILVERSTEIN:  It strikes me that if we were to move forward
that addressed the match between resources and need it might be the
umbrella under which a number of different things could fit.  And you're
right.  When David Michaels talks to us tomorrow, he's going to tell us
some of the conclusions he's reached about areas where the agency is not
-- the resources are not being deployed properly.  We've heard hints
about some of those things from the last time.  But he may tell us that
vulnerable workers, attention to vulnerable workers is an area that
needs attention, injury and illness prevention Programs.   I think there
are a number of things that would fit in that umbrella.

		Denise, you had your hand up.

		MS. POUGET:  Yes.  Along the near miss line, I'll just volunteer to do
this, if we have time tomorrow.  We're exploring that topic.  The
International Association of Fire Chiefs has promoted a program for
probably going on five years now that you can get online and totally and
completely anonymously report a near miss and it's in the firefighters
or witnesses or officers and in words.  And the great part about is that
they collect this data.  They push this data out so that we can learn
from the mistakes.  And it's not a punitive thing and so forth.  And it
was designed based on the FAA's way of reporting.  They went from the
seventies to 19 air crashes to like zero to one a year.

		It would be kind of interesting it just strikes me if you go to
OSHA.gov and pick your industry, construction or whatever, and file a
near miss and then people could have the access in similar ways.  But
it's just a thought.  I could show it to you if we get Internet access
in here.  I don't know if we do or not.  But it's pretty neat.

		CHAIRMAN SILVERSTEIN:  We're scheduled to go until 4:30 and we have
about two minutes left, maybe three.

		Here is what I would like you to do overnight.  I'd like you to think
about three things.  The first is with regard to Idea No. 1.  I want you
to think, and I'll repeat it in a second.  With regard to Idea No. 1, I
want you to think about whether or not this would be a good idea for us
to focus on and whether or not there's a better way to articulate it. 
Since I will now tell you now in a rather incoherent what this idea is. 
It's in the area of providing advice to the agencies about how they can
function strategically so that resources best match needs.  That's Idea
No. 1.  Think about whether or not it's a good idea for us to work on. 
Secondly, is there better language to capture it.

		Idea No. 2, and the same questions with regard to Idea No. 2.  How can
the agencies or how can we as a nation better ensure that worker
protection get higher priority than it currently gets.  And that might
be in the context specifically of emergencies, but maybe it's even a
broader consideration.  So think about whether or not that's a good idea
for us to work on.  And secondly, is there a better way to capture it in
words?

		And then the third question for you think about overnight is there a
No. 3 or a No. 4 that you think really we ought to be thinking about
working on.  And then let's take the first hour of tomorrow before David
Michaels comes in to see what your thoughts have been overnight.  And
we'll listen to him and maybe everything will change after that.  And
then we have time built into the agenda tomorrow to really again
continue this brainstorming so that by the end of tomorrow we've mapped
out direction.

		Does that work for everybody?  Okay.

		(Whereupon, at 4:29 p.m., the meeting in the above-entitled matter
adjourned, to reconvene the following day, Wednesday, September 15,
2010.)

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	REPORTER'S CERTIFICATE

DOCKET NO.:	N/A

CASE TITLE:	NACOSH Meeting

HEARING DATE:	September 14, 2010

LOCATION:		Washington, D.C.

		I hereby certify that the proceedings and evidence are contained fully
and accurately on the tapes and notes reported by me at the hearing in
the above case before the Department of Labor / Occupational Safety and
Health Administration.

				Date:  September 14, 2010

				                             

				Chris Mazzochi

				Official Reporter

				Heritage Reporting Corporation

				Suite 600

				1220 L Street, N.W.

				Washington, D.C.  20005-4018

 

 

	TRANSCRIPT OF PROCEEDINGS

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