A leading group of occupational
doctors is taking the unusual step of speaking out publicly against pressure
from companies to downplay workplace injuries.
To outline their concerns, the
physicians have sent a letter to federal workplace safety regulators and held a
conference session in New York City on Monday. They're also planning to testify
If successful, their campaign
could affect the treatment of injured workers and might help change how the
government assesses workplace safety.
"Our members feel they are
being methodically pressured ... to under-treat and mistreat," said Dr. Robert
McLellan, president of the American College of Occupational and Environmental
Medicine. "...This is a grave ethical concern for our members. It's a grave
His group represents 5,000
doctors; some treat workers referred to them by employers, while others work
directly for companies.
Employers are supposed to
record all injuries requiring time off work or medical treatment beyond first
aid. It's an honor system, and the injury logs are used by regulators and
others to gauge plant safety. Low injury rates allow companies to avoid
scrutiny from workplace safety regulators and may help managers earn
In a hotel meeting room in New
York, doctors said this helps explain why some employers urge them not to treat
injuries in a way that would make them reportable. A cut, for instance, must be
recorded if the worker gets stitches, one doctor told the room of more than 60
colleagues. But if the doctor simply covers the cut with a bandage, it doesn't
have to be reported.
Workplace injury and illness
rates -- a key factor in determining whether regulators inspect a company --
have been declining nationwide in recent years. But some experts suspect that's
partly because employers aren't reporting all on-the-job injuries.
McLellan, an associate
professor at Dartmouth Medical School in New Hampshire, says he thinks
employers are "vastly underreporting" the extent of workplace injuries.
"Players in the system may
willfully produce records that don't reflect reality," he said in an
He said he grew more concerned
about corporate pressures on doctors in September, during a conference in the
Carolinas. Since then, he said, he has heard from dozens of doctors.
That led him to contact the
U.S. Occupational Safety and Health Administration, and he expects to discuss
his concerns with top agency officials next month. His group will likely
propose that OSHA more vigorously investigate the accuracy of company injury
logs. It may also ask regulators to rely on a broader array of workplace safety
measures -- and to rewrite rules so that companies have fewer incentives to
McLellan also wants
occupational doctors to testify before congressional committees examining
Ethical physicians sometimes
lose business to those who bend to the wishes of employers, some doctors and
workers' compensation lawyers say.
In the Carolinas and some other
states, injured workers generally must visit doctors approved by their
employers if they want workers' compensation to pay for the treatment.
Companies incur higher costs for compensating workers for medical care and lost
wages when they're injured on the job.
Employers tend to send workers
to doctors who can help them keep costs low and productivity high, according to
attorneys who represent injured workers. Doctors become popular with companies
if they rarely order time off work for injured employees, or if they seldom
recommend costly treatments or conclude injuries are work-related, those
"If you get past the infirmary
and sent to a doctor, you're getting sent to a doctor that lives on the plant,"
said lawyer David Davila, who until recently worked in Columbia, S.C.
Atlanta lawyer Bruce Carraway
has represented more than 400 injured poultry workers and says that in more
than half of those cases, independent physicians gave different assessments
than the company doctors.
Dr. Josephus Bloem, an
orthopedic surgeon from Rocky Mount, said he used to get referrals from Perdue
Farms. But in the 1990s, the company became unhappy that he usually recommended
surgery for workers with carpal tunnel syndrome.
"Their top doctor once visited
me and complained that I was too expensive, which I took as pressure to review
my approach," Bloem said. Not long afterward, the referrals stopped.
Dr. Roger Merrill, Perdue's
chief medical officer, said the company had discovered that many workers who
got less invasive treatment -- such as splinting, exercise and ibuprofen --
fared better than those who got surgery. "We had a better way to treat folks,"
But Bloem wondered whether
health concerns were the only factor. "In the end," he said, "the money
In their quest to keep injuries
off logs, company officials without medical training sometimes provide
inappropriate treatment, doctors at the New York conference said.
Dr. Peggy Geimer, corporate
medical director for a chemical company in Connecticut, spoke of the
"tremendous amount of pressure" on company staff to provide treatment beyond
their level of expertise.
She recalled how one supervisor
dealt with an injured worker who spilled an acidic chemical on his arm: He
applied potash, which is sometimes used to clean up chemical spills -- unaware
that it would only make the burn worse.
McLellan said he doesn't recall
his group ever before taking such a strong stance on the issue. As one doctor
at Monday's conference put it: "We need to treat the patient. Not the log."
-- Staff Writers Karen Garloch and Franco Ordonez contributed.
-- Ames Alexander:
Many injuries unreported in poultry
In a recent investigation of
working conditions in the poultry industry, the Observer found that many
on-the-job injuries aren't being reported.
One N.C. poultry company, House
of Raeford Farms, has repeatedly failed to record injuries on government safety
logs. The newspaper also found that some company first-aid attendants have
prevented poultry workers from receiving care that would cost the company
House of Raeford says it
follows the law, provides good care and strives to protect workers.
A record-keeping expert for the
U.S. Occupational Safety and Health Administration told the Observer that his
agency is allowing employers nationwide to vastly underreport the number of
workplace injuries. The true rate for some industries, including poultry
processors, is likely two to three times higher than government numbers
suggest, Bob Whitmore said.