Preventive Medicine : Standards on Cumulative Trauma Would Cover Every Employee in State


A ground-breaking safety proposal--a plan intended to protect all employees in California from the rapidly spreading ailments known as cumulative trauma disorders--comes under its first public scrutiny today.

The proposed standard, the subject of a hearing in Los Angeles, marks the first comprehensive effort by any state to prevent carpal tunnel syndrome, bursitis and other physical problems linked to repetitive on-the-job activities.

Drafted by the California Occupational Safety and Health Administration, the standard would apply to all employers and every type of employee, from secretaries to meatpackers. State law requires adoption of the standard by the end of 1994.


Cumulative trauma disorders, also called CTDs or repetitive stress injuries, have increased explosively to become the leading occupational illness in America. The most recent federal statistics report 281,800 cases of such disorders in private industry in 1992, up more than twelvefold from a decade earlier.

Consequently, the progress of the California proposal--with its potential to shape the anticipated national debate on work site ergonomics--is being watched by businesses and unions across the country. The Clinton Administration plans to issue its own preliminary ergonomics proposal around September.

The state standard would require California employers to take several measures. First, they would need to provide training alerting every worker to the early symptoms of CTDs. In addition, employers would need to review their medical, safety and workers’ compensation records to determine if their employees suffer CTD problems. They would also have to set up procedures for reporting such problems.

Firms would pay for eye examinations and eyeglasses for workers who use computer terminals and who are found to need new glasses specifically for their jobs.

For employers that have experienced CTD problems or are found to have CTD “risk factors,” the standard calls for further measures, including stepped-up training, work site evaluations and medical evaluations for the workers reporting symptoms.

“It is designed to be as preventive as possible,” said John Howard, director of Cal/OSHA.

Labor officials, while generally pleased with California’s preliminary ergonomics proposal, want its requirements tightened. Although there are major differences of opinion among business executives, a broad array of employers consider parts of the 26-page proposal too expensive, too inflexible and lacking in scientific justification.

Still, the proposal is more complicated than a simple attempt to strike a compromise.

Even though advocates regard it as an important initiative to spare workers the agony of painful ailments, the proposal is largely intended to solve a California business problem: high workers’ compensation costs.

Another interesting twist is the politics of the standard: It could be an awkward election-year issue for Gov. Pete Wilson, who is loath to offend business but whose Administration is under the gun to write a final plan before next January.

Officials at Cal/OSHA say they have been extremely sensitive to the concerns of business as well as labor in drafting the proposal. They say the standard would save employers money in the long run.

“The underlying premise is that it’s cheaper to prevent these CTD injuries than to allow them to occur,” director Howard said.

Labor leaders, for their part, cite afflicted workers such as Carmen Tapia of Boyle Heights. Tapia says she began suffering incapacitating pain and sometimes numbness in her right hand and wrist after working more than 20 years at a defense plant binding thick harness cables for Navy submarines.

“I couldn’t hold on to things anymore,” she said. “If I got a cup from the cupboard, it would slip out of my hand.”

The problem was later diagnosed as carpal tunnel syndrome, an ailment that Tapia, 60, could suffer from for the rest of her life despite undergoing surgery.

In many cases, “people don’t pay attention to the problem at first. People learn to put up with the pain over time, but that’s when they get something that’s permanent and irreversible,” said Len Welsh, a Cal/OSHA lawyer and the principal drafter of the proposed ergonomics standard.

Blue Cross of California, one of the few business concerns to warmly embrace the proposed standard, claims it has saved roughly $1 million a year in workers’ compensation expenses by adopting an ergonomics program for its own work force in 1990.

Ellen Ignatius, health and safety manager for Blue Cross, said the number of cases initially shot up after her company’s program was launched because employees were encouraged to report symptoms immediately. But, she said, because Blue Cross now steps in to remedy such problems when they are in their early stages, its medical costs have fallen dramatically.

“You don’t see people going into surgery anymore,” she said.

While skeptics note that Blue Cross could benefit financially if the companies it insures are forced to step up their ergonomics programs, Ignatius said the basis of her support for the state’s proposal is simply that it would effectively reduce CTD problems.

But major business interests, with direction from the California Chamber of Commerce, are pushing Cal/OSHA to rewrite much of the proposal before the year-end deadline. Chamber officials say the training and other requirements required of all employers, along with the eye exams for many computer users, could cost “hundreds of millions.”

The chamber is also seeking an exemption for small businesses.

Julianne Broyles, director of employment relations issues for the chamber, contended that the training requirement familiarizing workers with CTDs might spur bogus workers’ compensation claims. She speculated that more employees would start portraying injuries suffered on weekends as job-related so they can collect workers’ compensation benefits. “Are we opening up a can of worms?” she asked.

Opponents also want evidence that a CTD symptom “is reasonably likely to be work-related” before being required to provide medical attention. In addition, they challenge guidelines in the standard specifying such details as the type of back support computer operators’ chairs should have.

Scientists still know too little about CTDs “to know that if we do certain things they will have positive results,” said Renee C. Allison, lobbyist for the California Newspaper Publishers Assn., one of the members of the chamber coalition and an organization representing about 400 newspapers.

Cal/OSHA officials and their supporters, however, say that the standard would still give employers the flexibility to devise their own computer workstations, provided they are effective in preventing CTDs.

Today’s hearing on the standard will begin at 10 a.m. in the auditorium of the state office building at 107 S. Broadway in Downtown Los Angeles.

The Rapid Rise of CTDs

Cumulative trauma disorders, also known as CTDs or repetitive stress injuries, have increased explosively over the past decade to become the nation’s No. 1 occupational illness. CTDs include carpal tunnel syndrome, burstitis, hearing loss and other ailments resulting from repeated motions, pressures or vibrations experienced on the job.

1992 (in thousands):

All occupational illnesses: 457.4 CTDs: 281.8

Source: Bureau of Labor Statistics