Budget debate threatens to delay TB standard
January 1, 2000 3 minutes read
Budget debate threatens to delay TB standard
Yet OSHA remains on track for spring release
Opponents of a proposed federal tuberculosis standard gained ground as congressional battles continued late into the fall over the budget of the U.S. Occupational Safety and Health Administration (OSHA).
The U.S. House Appropriations Subcommittee on Labor, Education, and Human Services voted to approve legislation that includes a $450,000 independent review of the need for a TB standard. The subcommittee also voted to slash OSHA’s budget by 5%, or $17 million. The president has requested $388.1 million in FY2000, which includes a $12.1 million increase for federal compliance assistance and $8.3 million for federal enforcement.
The provision requiring an independent review by the Institute of Medicine represented a victory for opponents of the proposed TB standard, which is due out this spring. But OSHA officials say they will move forward unless they are expressly prohibited from implementing a standard.
"We’re working toward having a spring publication, barring any unforeseen decisions," says Amanda Edens, team leader for the TB standard at OSHA.
The Washington, DC-based Association for Professionals in Infection Control and Epidemio logy (APIC) has strongly opposed the proposed TB standard, calling it unnecessary, burdensome, and a misdirection of resources. They want OSHA to delay the TB standard until the completion of a study.
"It’s not that we don’t think TB disease is an issue. It’s a public health care issue," says Jennifer Thomas, APIC’s director of governmental and public affairs. "These precious dollars need to go in the public health arena. Everything in the rule is geared toward adding protections for health care workers, and they’re not the ones at risk."
Thomas notes that as the incidence of TB declined in the 1990s, most of the hospital-based exposure occurred with patients who hadn’t previously been diagnosed. However, worker safety rules govern precautions that must be taken with patients who are known to have TB.
"TB is largely a problem because of the undiagnosed patients, those who are asymptomatic," says Thomas. "You can’t control for TB any more than we already are with this rule."
OSHA has responded to concerns about the TB standard by making changes to conform to existing guidelines of the Centers for Disease Control and Prevention in Atlanta. For example, the frequency of skin testing was changed from every six months to every 12 months to reflect the CDC recommendation, says Edens.
"We’re trying to be as much like CDC guidelines as possible so that people currently following CDC guidelines would continue to do what they would normally be doing," she says.
Provisions for annual fit-testing of respirators will reflect recommendations of the National Institute for Occupational Safety and Health and OSHA’s more general respiratory protection standard, says Edens.
Thomas contends that the measures should be risk-based, taking into account that some regions of the country very rarely see even a single patient with tuberculosis, while urban areas with a high immigrant population may have occasional outbreaks. APIC also asserts that an OSHA rule that codifies existing CDC guidelines is unnecessary.
Voluntary guidelines give no recourse
"CDC guidelines are voluntary. We recognize that some people are voluntarily using them, and that’s great," responds Edens. "But we want to see that those employees in settings where they’re not voluntarily following the guidelines have the same protection. If there are employers who elect not to follow the recommendations and they put employees at risk, the employee has no recourse [with voluntary guidelines]. With an OSHA rule, there’s a mechanism so the employee can file a complaint and get the appropriate protection put in place."
Meanwhile, even if OSHA’s budget is cut, federal enforcement of worker safety rules isn’t likely to suffer. A review of OSHA’s budget history for the past eight years shows that while budgets have declined in some years and increased in others, federal enforcement and compliance assistance did not always take the reduction.
If increased funds are allotted this year, OSHA plans to expand outreach and training for employees and employers and boost the targeted inspection of workplaces that have "serious safety and health problems," assistant secretary of labor for occupational safety and health Charles N. Jeffress said in a published statement.
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