Current through Register Vol. 24-06, March 15, 2024
(1)
General.
(a) The employer must
make medical surveillance required by this section available at no cost to the
employee, and at a reasonable time and place, to each employee:
(i) Who is or is reasonably expected to be
exposed at or above the action level for more than 30 days per year;
(ii) Who shows signs or symptoms of CBD or
other beryllium-related health effects;
(iii) Who is exposed to beryllium during an
emergency; or
(iv) Whose most
recent written medical opinion required by this section recommends periodic
medical surveillance.
(b) The employer must ensure that all medical
examinations and procedures required by this standard are performed by, or
under the direction of, a licensed physician.
(c) When requested by an employee who
provides the employer with an abnormal or borderline finding for a single blood
BeLPT or two borderline blood BeLPT, the employer must arrange for medical
examinations and procedures to be performed at a CBD diagnostic center that is
mutually agreed upon by the employer and the employee, or at the CBD diagnostic
center requested by the employee, when the center is recognized by the
department as a center for research and clinical assessment of chemically
related illness (see
RCW
51.32.360).
(2)
Frequency. The employer must
provide a medical examination:
(a) Within 30
days after determining that:
(i) An employee
meets the criteria of subsection (1)(a)(i) of this section, unless the employee
has received a medical examination, provided in accordance with this standard,
within the last two years; or
(ii)
An employee meets the criteria of subsection (1)(a)(ii) of this
section.
(b) At least
every two years thereafter for each employee who continues to meet the criteria
of subsection (1)(a)(i), (ii), or (iv) of this section.
(c) At the termination of employment for each
employee who meets any of the criteria of subsection (1)(a) of this section at
the time the employee's employment terminates, unless an examination has been
provided in accordance with this standard during the six months prior to the
date of termination. Each employee who meets the criteria of subsection
(1)(a)(iii) of this section and who has not received an examination since
exposure to beryllium during the emergency must be provided an examination at
the time the employee's employment terminates.
(d) For an employee who meets the criteria of
subsection (1)(a)(iii) of this section:
(i) If
that employee has not received a medical examination within the previous two
years pursuant to subsection (1)(a) of this section, then within 30 days after
the employee meets the criteria of subsection (1)(a)(iii) of this section;
or
(ii) If that employee has
received a medical examination within the previous two years pursuant to
subsection (1)(a) of this section, then at least one year but no more than two
years after the employee meets the criteria of subsection (1)(a)(iii) of this
section.
(3)
Contents of examination.
(a) The
employer must ensure that the PLHCP conducting the examination advises the
employee of the risks and benefits of participating in the medical surveillance
program and the employee's right to opt out of any or all parts of the medical
examination.
(b) The employer must
ensure that the employee is offered a medical examination that includes:
(i) A medical and work history, with emphasis
on past and present airborne exposure to or dermal contact with beryllium,
smoking history, and any history of respiratory system dysfunction;
(ii) A physical examination with emphasis on
the respiratory system;
(iii) A
physical examination for skin rashes;
(iv) Pulmonary function tests, performed in
accordance with the guidelines established by the American Thoracic Society
including forced vital capacity (FVC) and forced expiratory volume in one
second (FEV1);
(v) A standardized
BeLPT or equivalent test, upon the first examination and at least every two
years thereafter, unless the employee is confirmed positive. If the results of
the BeLPT are other than normal, follow-up BeLPT testing must be offered within
30 days, unless the employee has been confirmed positive or unless the employee
requests a medical examination as according to subsection (1)(c) of this
section. Samples must be analyzed in a laboratory certified under the College
of American Pathologists/Clinical Laboratory Improvement Amendments (CLIA)
guidelines to perform the BeLPT;
(vi) A low dose computed tomography (LDCT)
scan, when recommended by the PLHCP after considering the employee's history of
exposure to beryllium along with other risk factors, such as smoking history,
family medical history, sex, age, and presence of existing lung disease;
and
(vii) Any other test deemed
appropriate by the PLHCP.
(4)
Information provided to the
PLHCP. The employer must ensure that the examining PLHCP (and the
evaluating CBD diagnostic center, if an evaluation is required under subsection
(7) of this section) has a copy of this rule and must provide the following
information, if known:
(a) A description of
the employee's former and current duties that relate to the employee's airborne
exposure to and dermal contact with beryllium;
(b) The employee's former and current levels
of airborne exposure;
(c) A
description of any personal protective clothing and equipment, including
respirators, used by the employee, including when and for how long the employee
has used that personal protective clothing and equipment; and
(d) Information from records of
employment-related medical examinations previously provided to the employee,
currently within the control of the employer, after obtaining written consent
from the employee.
(5)
Licensed physician's written medical report for the employee.
Exception:
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When the PLHCP assists the worker in filing a claim
under Title 51 RCW, Industrial insurance, the PLHCP does not need to prepare a
separate report for the employee if all the information required in this
section is entered into the claim record, the report is directly shared with
the employee, and the PLHCP explains the results of the examination to the
employee. The PLHCP may provide additional reports or notes to make sure the
employee understands the results of the examination and recommendations.
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The employer must ensure that the employee receives a written
medical report from the licensed physician within 45 days of the examination
(including any follow-up BeLPT required under subsection (3)(b)(v) of this
section) and that the PLHCP explains the results of the examination to the
employee. The written medical report must contain:
(a) A statement indicating the results of the
medical examination, including the licensed physician's opinion as to whether
the employee has:
(i) Any detected medical
condition, such as CBD or beryllium sensitization (i.e., the employee is
confirmed positive, as defined in WAC
296-850-090), that may place the
employee at increased risk from further airborne exposure; and
(ii) Any medical conditions related to
airborne exposure that require further evaluation or treatment.
(b) Any recommendations on:
(i) The employee's use of respirators,
protective clothing, or equipment; or
(ii) Limitations on the employee's airborne
exposure to beryllium.
(c) If the employee is confirmed positive or
diagnosed with CBD or if the licensed physician otherwise deems it appropriate,
the written report must also contain a referral for an evaluation at a CBD
diagnostic center.
(d) If the
employee is confirmed positive or diagnosed with CBD, the written report must
also contain a recommendation for continued periodic medical
surveillance.
(e) If the employee
is confirmed positive or diagnosed with CBD, the written report must also
contain a recommendation for medical removal from airborne exposure to
beryllium, as described in WAC
296-850-160.
(6)
Licensed physician's written
medical opinion for the employer.
Exception:
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When a claim has been initiated the PLHCP does not need
to prepare a separate report for the employer if all information required in
this section is entered into the claim record. As part of initiating a claim,
the employee agrees to share all of the relevant medical records, and the
limits on information reported to the employer in this section do not
apply
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(a) The employer
must obtain a written medical opinion from the licensed physician within 45
days of the medical examination (including any follow-up BeLPT required under
subsection (3)(b)(v) of this section). The written medical opinion must contain
only the following:
(i) The date of the
examination;
(ii) A statement that
the examination has met the requirements;
(iii) Any recommended limitations on the
employee's use of respirators, protective clothing, or equipment; and
(iv) A statement that the PLHCP has explained
the results of the medical examination to the employee, including any tests
conducted, any medical conditions related to airborne exposure that require
further evaluation or treatment, and any special provisions for use of personal
protective clothing or equipment.
(b) If the employee provides written
authorization, the written opinion must also contain any recommended
limitations on the employee's airborne exposure to beryllium.
(c) If the employee is confirmed positive or
diagnosed with CBD or if the licensed physician otherwise deems it appropriate,
and the employee provides written authorization, the written opinion must also
contain a referral for an evaluation at a CBD diagnostic center.
(d) If the employee is confirmed positive or
diagnosed with CBD and the employee provides written authorization, the written
opinion must also contain a recommendation for continued periodic medical
surveillance.
(e) If the employee
is confirmed positive or diagnosed with CBD and the employee provides written
authorization, the written opinion must also contain a recommendation for
medical removal from airborne exposure to beryllium, as described in WAC
296-850-160.
(f) The employer must ensure that each
employee receives a copy of the written medical opinion described in this
subsection within 45 days of any medical examination (including any follow-up
BeLPT required under subsection (3)(b)(v) of this section) performed for that
employee.
(7)
CBD
diagnostic center.
(a) The employer
must provide an evaluation at no cost to the employee at a CBD diagnostic
center that is mutually agreed upon by the employer and the employee, or at the
CBD diagnostic center requested by the employee, when the center is recognized
by the department as a center for research and clinical assessment of
chemically related illness (see
RCW
51.32.360). The examination must be scheduled
within 30 days, and must occur within a reasonable time, of:
(i) The employer's receipt of a physician's
written medical opinion to the employer that recommends referral to a CBD
diagnostic center; or
(ii) The
employee presenting to the employer a physician's written medical report
indicating that the employee has been confirmed positive or diagnosed with CBD,
or recommending referral to a CBD diagnostic center.
(b) The employer must ensure that, as part of
the evaluation, the employee is offered any tests deemed appropriate by the
examining physician at the CBD diagnostic center, such as pulmonary function
testing (as outlined by the American Thoracic Society criteria),
bronchoalveolar lavage (BAL), and transbronchial biopsy. If any of the tests
deemed appropriate by the examining physician are not available at the CBD
diagnostic center, they may be performed at another location that is mutually
agreed upon by the employer and the employee.
(c) The employer must ensure that the
employee receives a written medical report from the CBD diagnostic center that
contains all the information required in subsection (5)(a), (b), (c), and (e)
of this section and that the PLHCP explains the results of the examination to
the employee within 30 days of the examination.
(d) The employer must obtain a written
medical opinion from the CBD diagnostic center within 30 days of the medical
examination. The written medical opinion must contain only the information in
subsection (6)(a) of this section, as applicable, unless the employee provides
written authorization to release additional information. If the employee
provides written authorization, the written opinion must also contain the
information from subsection (6)(b), (d), and (e) of this section, if
applicable.
(e) The employer must
ensure that each employee receives a copy of the written medical opinion from
the CBD diagnostic center described in this subsection within 30 days of any
medical examination performed for that employee.
(f) After an employee has received the
initial clinical evaluation at a CBD diagnostic center described in (a) of this
subsection, the employee may choose to have any subsequent medical examinations
for which the employee is eligible under this section performed at a CBD
diagnostic center mutually agreed upon by the employer and the employee, or at
the CBD diagnostic center requested by the employee, when the center is
recognized by the department as a center for research and clinical assessment
of chemically related illness (see
RCW
51.32.360). The employer must provide such
examinations at no cost to the employee.