Chapter 3
HEALTH SERVICES

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3.1 Policy

The LBNL Health Services provides comprehensive occupational medicine services to LBNL full-time employees, part-time employees who work 30 days in a 12-month period, or all employees who participate in a medical surveillance program. Health Services policy ensures that employees are physically able to perform their assigned duties, ensures that employees with an occupational illness or injury receive medical care and rehabilitation, and provides for emergency treatment for serious illnesses or injuries. The policy also encourages all employees to maintain their physical and mental health and assists in maintaining a healthy and safe work environment. Health Services also supports LBNL’s provision of employee benefits through the Disability Management Program, which provides counseling and helps injured and ill employees rehabilitate and return to work safely. The Human and Animal Research Committees Office in Health Services coordinates the Lab's animal welfare and human subjects protection programs including the associated oversight committees.

Health Services is available to all employees hired for 30 days or more, or any employee subject to a medical surveillance program. First Aid and/or emergency services may be provided to subcontractors and guests until they are referred to their employer for industrial injury care or their personal physician for nonindustrial illnesses.

3.2 LBNL Health Services Program

The Health Services Clinical Program manages medical surveillance; provides preplacement, termination, and periodic health evaluations; provides first aid, initial assessment of injuries and illnesses, and appropriate referrals; provides case management; and contributes to health promotion through its Wellness Program. The program staff works closely with other EH&S staff to ensure the existence of an effective Medical Surveillance Program and with staff from Human Resources to help implement the Laboratory's Return-to-Work Policy.

3.3 Facility

The Health Services facility, located primarily on the first (top) floor of Building 26, houses the following:

3.4 Staff

The Health Services Group is staffed by the Site Occupational Medical Director, physicians, and registered nurses. The Site Occupational Medical Director and other LBNL health-care professionals providing clinical services are all licensed to practice in California, and most have additional special training in occupational medicine.

3.5 Physical Examinations

The Site Occupational Medical Director establishes the frequency and content of physical examinations based on OSHA regulations, DOE guidelines, and the standards of medical practice. A physical examination may include:

Prior to testing, employees are provided a verbal and written description of all recommended tests, including the nature of the test, the purpose, and results of testing. This discussion is documented in the medical record by the consent form and test explanation sheet.

3.6 Preplacement and Job Transfer Examinations

A complete and confidential medical examination is offered to new career employees and temporary employees hired for one month or longer. The components of the recommended examination are derived from the new employee's report of potential exposures. Unless there is a regulatory requirement stating otherwise, all components of the new employee physical examination are voluntary.

Current employees changing to a position that may result in exposure to new job hazards should complete the Job Hazards Questionnaire and a new “Employees Report of Potential Exposures” form.  This will allow for inclusion in new medical surveillance examinations, if appropriate.

3.7 Periodic Examinations

General health promotion examinations are also available on an age-related schedule. Employees under age 40 are offered a complete physical examination every five years; those between age 40 and 50, every three years; and those above age 50, every two years.

3.8 Termination Examinations

Employees terminating employment at LBNL may be advised to have a termination examination, depending on how recently the employee has undergone a periodic examination. (See Section 3.22.12 (Employees Terminating Employment).)

3.9 Medical Surveillance Program

The Medical Surveillance Program provides medical examinations and laboratory evaluations to monitor and protect employees who may be at risk from health hazards at work. Employees who may benefit from more frequent or additional voluntary medical examinations and laboratory evaluations include the following:

In addition, either LBNL employees or the Health Services group (in consultation with Industrial Hygienists) may arrange for voluntary medical evaluations under the following circumstances:

• Whenever an employee develops signs or symptoms associated with a hazardous chemical to which the employee may have been exposed in the laboratory,
• Exposure monitoring demonstrates exposure above the action level or permissible exposure limit for a regulated chemical with a medical surveillance requirement,
• Any laboratory incident that results in the likelihood of a hazardous exposure, or
• Significant questions arise about possible health effects of novel compounds, such as engineered nanoparticles.

In carrying out its medical surveillance activities, Health Services depends on the cooperation and collaboration of Industrial Hygiene, Analytical Services, and Radiation Protection. (For general health concerns, see also Section 3.7, Periodic Examinations.)

3.10 Examinations for Laser Users

Users of Class 3B and Class 4 lasers are required to undergo an eye examination performed by an optometrist before they can begin working with lasers and after any accidental exposure to a laser. Contact Health Services for an appointment (extension 6266) for an examination.

3.11 Return-to-Work Policy

The Berkeley Lab Return-to-Work Policy requires employees returning to work after one full day or more of lost time due to a work-related illness or injury to report to Health Services for an evaluation of their condition and ability to resume customary work. Employees who have been absent for five or more consecutive workdays due to nonoccupational illness or injury also are required to report to Health Services so that their ability to return to work can be determined.

3.12 Medical Records

Complete medical records are maintained for employees from the time of their first physical examination. These records are confidential to the extent provided by law and remain in the custody and control of Health Services.

Information from an employee's health records may be disclosed only as required by law or if an employee provides written consent for release of information. Records are retained indefinitely.

3.13 Work Restrictions

Work restrictions may be placed on an employee's work based on the results of his or her physical examination, illness, or injury.

3.14 Pregnancy

A health professional will discuss with a pregnant employee her work environment and determine whether any changes are required to protect the employee and her baby. See Section 21.9.4 (Declared Pregnant Workers), in Chapter 21 (Radiation Safety).

3.15 Medical Emergencies and First Aid

FOR EMERGENCIES, CALL:

From any LBNL phone on-site or off-site: DIAL 7911

From a 642 or 643 PREFIX: DIAL 9-911

From a cellular phone: DIAL 911

FROM 7:30 A.M. TO 3:30 P.M., FIRST AID IS AVAILABLE IN HEALTH SERVICES, BLDG. 26, EXT. 6266.

AT ALL OTHER TIMES, EMERGENCY MEDICAL SERVICES ARE AVAILABLE FROM THE FIRE DEPARTMENT THROUGH THE 7-911 DISPATCH SYSTEM.

First aid is provided for occupational injuries and illnesses. Treatment is coordinated with outside specialists according to Workers' Compensation guidelines.

Employees are provided with primary aid at the site where the injury occurred if they cannot be moved from the site; treatment is provided by LBNL physicians, nurses, firefighters, and emergency medical technicians (EMTs) in charge of the LBNL ambulance

3.16 Transportation of Sick or Injured Personnel

Employees who are severely injured or become seriously ill at work will be transported to nearby hospitals, according to dispatch center directions.

Transportation of less seriously injured employees will be managed on a case-by-case basis.

3.17 Radiological Accidents

EH&S notifies LBNL health care professionals of accidental exposures to radiation. In the event of contamination by radioactive isotopes or possible activation by high-energy beams, an employee may be given a whole-body count and have a radiochemical analysis of urine done by Technical Services staff. The actions of the health care professionals include possible treatment and notification. The type and severity of the exposure or spill will determine the actions taken by the health care professionals.

LBNL has a mutual aid agreement with a local hospital to admit and care for LBNL employees who are either radioactively contaminated or both radioactively contaminated and injured.

3.18 Safety Glasses

Safety glasses are supplied to employees free of charge. Employees can make an appointment with the optometrist, ext. 6266, in Health Services to have safety glasses fitted. The optometrist can also perform refractions for a fee for employees who require safety glasses but do not have a recent prescription.

3.19 The Employee Assistance Program (EAP)

The Employee Assistance Program (EAP), an off-site contract service provided by CARE Services of the University of California Health Center (the Tang Center) on the Berkeley campus, offers confidential consultation, assessment, and referral for personal or work-related problems. Employees may seek help directly from the EAP or may be referred by a supervisor. EAP psychological records are maintained separately from LBNL Health Services medical records at an off-site location.

3.20 Immunizations and Biosafety Concerns

Immunizations are available to employees who require such protection during the course of their work at the Laboratory or during work-related travel. Yearly immunization against influenza may be offered to all employees. For certain types of biological exposures reviewed by the LBNL Biosafety Committee, it may be recommended that a sample of employee blood serum be stored in advance of exposure to the biological agent. Details of the immunization and serum banking procedures are available on the Health Services Web site.

3.21 Privacy Notice

The State of California Information Practices Act of 1977 (effective July 1, 1978) requires LBNL to provide the information on the Privacy Notice form to individuals who are asked to complete medical history forms or otherwise supply personal information.

The information on the forms is requested by Health Services for purposes of maintaining a complete medical record for each LBNL employee. Furnishing the requested information is voluntary and is intended to help protect the health of LBNL employees.

All information in employees' medical records is available only to Health Services staff. Information from medical records is maintained confidentially according to current laws. The information may be used as a basis for recommendations by Health Services to various LBNL and University departments in miscellaneous personnel matters (e.g., consideration for employment, transfer, work assignment, or eligibility for benefits).

Individuals have the right to review their records in accordance with LBNL and University policies. Information about these policies may be obtained from the Human Resources Department. (See Section 3.22.1 (Site Occupational Medical Director).)

3.22 Responsible Parties

The following people and parties are responsible for implementing Health Services policies:

3.22.1 Site Occupational Medical Director

3.22.2 LBNL Occupational Health Nurses

3.22.3 LBNL Contract Physicians and Nurse Practitioners

3.22.4 Laser Safety Officer

3.22 5 Analytical Services

3.22.6 Radiation Protection Program

3.22.7 Career and Temporary Employees

3.22.8 Employees with a Nonoccupational Illness or Injury

3.22.9 Employees with an Occupational Illness or Injury

3.22.10 Pregnant Employees

3.22.11 Employees Working with Lasers

3.22.12 Employees Terminating Employment

• Are encouraged to complete a termination questionnaire when employment is terminated at LBNL.

3.22.13 Human Resources

• Provides the Site Occupational Medical Director access to de-identified data from health, disability, and other insurance plans to help guide the creation of cost-effective health-promotion programs targeting preventable causes of morbidity and mortality.

3.23 Glossary

Confidentiality of medical records provides that medical information cannot be released outside Health Services without the written consent of the employee except as required by law.

Contract medical staff include physicians, nurse practitioners, and nurses. Contract physicians are not LBNL employees.

Occupational illness or injury is an illness or injury arising out of or in the course of employment.

3.24 Standards

3.25 Related LBNL/PUB-3000 Chapters

3.26 References