Joey Wahler (Host): It addresses work related health issues or injuries. So we're discussing Occupational Health Service at MIT Health. Our guests from Occupational Health Service at MIT Health are Dr. Neil Jenkins, he's Clinical Director, Kate Derr, the Nursing Manager, and Hannah Zivalic, a Certified Occupational Health Nurse.

This is Conversations with MIT Health. Thanks for joining us. I'm Joey Wahler. Dr. Jenkins, Kate, Hannah, welcome.

So first for you, Dr. Jenkins, what do we in essence mean for those unaware by the term Occupational Health?

Neil Jenkins, MD: Occupational Health focuses on the well being of people while they're at work or otherwise performing job duties. We treat work related injuries and illnesses, but we also try to prevent those from happening in the first place. Occupational Health providers need to interact with employers and other occupational safety professionals, and they need to stay up to date on the laws and regulations that govern the workplace and public safety. And there are some workplaces that have fairly unique health risks. So, there are many people and their healthcare providers that never encounter those things.

Host: So speaking of health risks, Hannah, what kinds of injuries or illnesses can typically occur at work? What's most common?

Hannah Zivalic , RN: Well, hearing loss from noise exposure is the most common workplace injury worldwide, although the non fatal work related condition that uses the most healthcare resources is low back pain. Overuse injuries to the hands, arms, and shoulders are probably next to that. Allergies compromise about 20 percent of occupational health illnesses.

Almost half of viral hepatitis infections are caused by Occupational Health needle sticks, and motor vehicle accidents cause almost half of all Occupational Health trauma and assault, another 20%. Beyond that, it is somewhat specific to the job. Construction workers experience falls and electrocution.

Mining and farming have heavy equipment accidents. Fishing has drowning, hypothermia, and so on.

Host: Right, so that covers a lot of ground generally speaking, which is great. But Dr. Jenkins, what kinds of health and safety risks are found specifically at MIT?

Neil Jenkins, MD: We have a little bit of almost every sort of hazard you can think of. We have 200 urban acres with 200 buildings of various sizes that have to be maintained by numerous housing and facilities workers with all the risks associated with manual labor, exposure to solid and liquid waste, cleaning agents, ladders, electricity, power tools, heavy equipment, and vehicles.

We have 15 million square feet of laboratories that produce a quarter of a million pounds of hazardous waste every year. There are about 5,000 laboratory workspaces specially designated to have a registered hazard, including all sorts of chemicals, human or animal tissues, many types of infectious bacteria or viruses, about 500 radiation sources, and we have a nuclear reactor.

There are about 100,000 research animals, mostly mice,

not only are researchers exposed to bites and allergens from these animals, but we have about 200 employees that take care of these animals eight hours a day, every day of the week. MIT has its own electrical power plant, where workers can be exposed to high voltages and loud noise.

We also have about 50 police officers, a team of volunteer EMTs, 200 clinical health care workers, who help treat and prevent injuries, but while doing so, they are also exposed to their own health risks. So, like I said, a little bit of everything.

Host: Indeed. Clearly, MIT, a world literally unto itself in a lot of ways, right? And you covered some of the things that I guess most of us outside of that world wouldn't necessarily consider. Hannah, how is Occupational Health different than say, environmental health and safety?

Hannah Zivalic , RN: Environmental health and safety professionals do not provide medical consultation or treatment. They make recommendations to reduce the level of risk posed by a workplace by eliminating or reducing hazards, installing engineering controls, or by providing training or personal protective equipment. The focus of EHS is on what is best for the majority of workers, whereas Occupational Health providers tend to focus on the individual worker and their specific medical needs.

Host: So Kate, with that being said, let's bring you in here. And how does Occupational Health service differ from the rest of MIT health? Because MIT health is a big world itself as well, right?

Kate Derr, DNP: So, the chief difference is that Occupational Health is not really a benefit that is offered to employees or students, it is actually a right of employees and students to receive Occupational Health services. MIT is responsible to provide a safe workplace according to law, best practice, and regulation.

And because of that, everything that we do at Occupational Health must be provided free of charge. And that means no co-pays, no insurance, no cost. That also means, that the entire MIT community can be seen at Occupational Health. And that includes all faculty, staff, and students of MIT's Cambridge campus and MIT's Lincoln Laboratory campus.

But this also includes the employees of the Whitehead Institute, the Broad Institute, and Draper Laboratory. All in all, this is a bit more than 20,000 employees and 10,000 students, which is quite impressive.

Host: Indeed, it is. And so you've all provided so far kind of a nice general outline. Back to you, Dr. Jenkins. And that all being said, what services are offered by Occupational Health?

Neil Jenkins, MD: We provide four groups of services. One, individualized risk assessments. Two, fitness evaluations. Three, medical surveillance. And four, work injury management.

Host: So maybe walk us through just in essence, what each of those four are and include, if you would please, the difference between a risk assessment and a fitness evaluation.

Neil Jenkins, MD: Sure. So, workplace environments are ideally designed to be reasonably safe for most people. But every individual is somewhat unique, and some individuals may be at greater risk in their given workplace than others. We provide you with a no cost, personalized evaluation to determine if the existing administrative and engineering safety controls in your given workplace are sufficient for your personal medical status.

And if not, we try to provide custom remedies that reduce your individual risk. Such as vaccination for hepatitis B or tetanus, voluntarily worn personal protective equipment, strengthening therapies, or education and training. Any personal medical information that you divulge to us is kept confidential and not provided to your employer.

The Occupational Safety and Health Administration, OSHA and the Association for Accreditation of Laboratory Animal Care, ALAC, requires employees to offer such personal valuations at no cost to all laboratory and animal workers, but employees are not required to participate if they so choose. For a workplace of particular concern.

We will use that workplace's chemical hygiene plan, biosafety protocols, and or training programs to recommend individual risk assessment to the affected employees. So that is what we mean by individual risk assessments.

Host: And then what would a fitness evaluation involve?

Neil Jenkins, MD: In some ways, a fitness evaluation is also an individual risk assessment, but it's from the viewpoint of the employer with regard to public safety. Under the Americans with Disabilities Act and the Family Medical Leave Act, an employer has the right and responsibility to determine if an employee has the medical capability to safely perform the essential duties of that person's job.

For example, someone with uncontrolled seizures should not be driving a bus, and someone with active tuberculosis should not be working with medical patients These laws only allow fitness evaluations to occur under certain circumstances, and they only allow the employer to find out whether or not the employee has the functional capacity to do their job.

No personal medical information is allowed to be shared with the employer. So Occupational Health acts as a gatekeeper, an intermediary, to protect the employee's privacy, while also serving to protect the public. Here at MIT, we do fitness evaluations for healthcare workers, , our nuclear reactor operators, and people who climb high towers, use cranes and hoists, or drive large or commercial vehicles.

Host: Boy, that's quite a spectrum of jobs that people have at MIT, again, giving people an idea of exactly what a big world it is. How about Dr. Jenkins, you also mentioned the term medical surveillance. What does that involve?

Neil Jenkins, MD: Right, so medical surveillance uses validated methodologies, if such exists, to monitor the health of individual workers whose work causes them to have unacceptably high levels of exposure to a potential hazardous agent. The goal is to see if there are early signs of exposure or disease in individual workers, as well as to find trends in the worker population that can be addressed with improved preventive measures.

Unfortunately, we do not have the medical science to do such monitoring for all sorts of workplace hazards. OSHA has set up standards for the hazards that we can monitor to indicate when an employer is required to provide medical surveillance to its employees, again, at no cost and with no obligation of the employees.

Luckily, in a laboratory environment like we have at MIT, we generally work with relatively small amounts of material at any given time. So, there's usually a way to use engineering controls to limit exposures to reasonable levels where medical surveillance isn't needed. Here at MIT, we have medical surveillance for exposures to loud noise, beryllium, lead, cadmium, and anion origins.

None of the personal and medical information collected through medical surveillance is made available to your employer, and it must be kept securely by Occupational Health.

Host: So Kate, if someone suffers a work related injury, how do they initiate the process of having it addressed?

I want

Kate Derr, DNP: Well, first and foremost, and this is the most important piece of information, if you are injured or believe you have been exposed to something that will result in injury or illness, you should seek immediate appropriate medical attention. We do offer urgent care here at MIT Health, but you are free to go to a local ER or see your personal physician.

I will say that the Occupational Health team here at MIT collaborates with the urgent care team. The Urgent Care team here at MIT Health is familiar with the various workplaces and biological exposures here at MIT. For example, animal bites, needle sticks, etc. The collaboration between, you know, the two groups does allow for a very efficient care process.

Like Occupational Health, Urgent Care at MIT will see everyone in the extended MIT community as well. The employee or student may also make an appointment with a member of our Occupational Health team as well. The second thing you should do is have your supervisor submit an injury report.

And what this does is it initiates an investigation into the injury, by the offices of Environment, Health and Safety, Workers Compensation and Insurance. And this practice, helps to ensure that the worker receive the medical care needed, also determines the cause of the injury or exposure, and make sure that the injury or exposure does not happen again.

All serious injuries do get reported to OSHA, and to assist in this investigation, we do ask that the injured worker, pays a visit to Occupational Health, for an administrative visit. And we ask this is done usually within a week of the injury or exposure, but it, you know, certainly at the employee's convenience works as well.

And I'm going to have Hannah now explain what an employee or student can expect at that Occupational Health, visit.

Hannah Zivalic , RN: So at this visit, you are not required to receive medical treatment from Occupational Health, but you can receive it if you choose. The advantage of seeing us in Occupational Health is that we work closely with MIT EHS, with the MIT Workers Compensation Office, and with many MIT supervisors. So, not only do we have a better understanding of your workplace than other healthcare providers, but we can help make sure your workers compensation claim is processed, that EHS gets all the necessary information they need.

And ensure that you are able to return to work in a safe fashion. Sometimes your return to work will involve work restrictions that enable you to heal without reinjuring yourself or injuring other people. Occupational Health is skilled at setting up reasonable work restrictions that benefit both the employee and employer.

Employers need to find out the medical information that is related to your work injury in order to process your workers' compensation claim and to report to OSHA as needed. Your medical provider will be asked to provide MIT with basic information about your work related injury. But otherwise, medical providers must keep personal medical information unrelated to the injury private and secure.

If you do all of these things, your medical care, regardless of where you get it, will be covered by workers compensation. If you are not an employee who receives workers compensation, but you were injured at MIT, MIT is committed to reimbursing your out of pocket expenses that insurance does not cover. Again, there is no cost.

Host: So, a couple of other things, Dr. Jenkins, if someone is reluctant to follow Occupational Health guidelines, something you touched on briefly earlier, how do you balance their needs with those of MIT in a situation like that?

Neil Jenkins, MD: So, Occupational Health needs to be a neutral third party that sits between the employer slash university, MIT, and the employees slash students. Both employers and employees have rights and responsibilities towards one another that we need to acknowledge and respect. So we at Occupational Health try to be fair, nonjudgmental mediators who help improve the community for everyone. So, for example, if someone were to ask me to test them for an exposure that they had at their prior job, not at MIT, I would explain to them that I would help them get tested, but that it would need to be billed to their health insurance, because I couldn't authorize MIT funds to pay for it.

It would not be fair to all the researchers at MIT whose research grants help pay for Occupational Health, to pay for another institution's responsibility. It is a fundamental part of Occupational Health to be constantly aware of the conflicting components of ethical behavior. Not only do we try to do good and do no harm, but we also must balance the autonomy and rights of an individual versus justice, fairness, and the good of the many.

Host: Well put. And so, in summary here, Hannah, what would you say are the long term goals of the Occupational Health Service at MIT?

Hannah Zivalic , RN: Better communication, we are working on currently improving our web presence and improving our online data management. We hope to make it possible for everyone at MIT to access their individual Occupational Health record at any time they wish.

Host: Well, I'm glad we could make this particular forum a small part of what you're all doing. Folks, we trust you're now more familiar with Occupational Health Service at MIT Health. Dr. Jenkins, Kate, Hannah, great job. Thanks so much again.

Neil Jenkins, MD: Thank you.

Kate Derr, DNP: Thank you.

Hannah Zivalic , RN: Thank you.

Host: And for more information and to connect with a provider, please visit health.mit.edu/services/occupational-health. For more health tips and updates, please follow MIT Health on your social channels. If you found this podcast helpful, please share it on your social media.

I'm Joey Wahler, and thanks again for being part of Conversations with MIT Health.