Cal/OSHA Lead Standards Revision Advisory Committee

Cal/OSHA Lead Standards Revision Advisory Committee

Minutes for Meeting February 23, 2011

Mary Gene Ryan CSAOHN

LeAnna Williams County of San Bernardino

John A DePaul Quemetco City of Industry

Patricia Coyle, OLPPP, CDPH

Vickie Wells, SFDPH

Holly Brown-Williams, UC Berkeley

Eric Rozance, Phylmar

Scott Levy, WOEMA; Kaiser Permanente

Julia Quint

Jeff Jones, Port of Oakland

Julie Pettijohn, OLPPP, CDPH

Mary Deems, OLPPP, CDPH

Frank Redle, Association of Environmental Contractors

Paul Papanek, WOEMA

Linda Morse, Kaiser Occupational Health

David Harrington, OHB, CDPH

Jeremy Smith, State Building Trades

Robert Ikenberry, CEC

Barbara Materna OHB, CDPH

Tom Mitchell OSHSB

Perry Gottesfeld, OK International

Michael Kosnett, University of Colorado School of Medicine

Peter Robinson, CalTrans

Ray Meister, OHB, CDPH

Malcolm Driggs, OETT/IUOEL #12

Teresa Fricke, San Bernardino County Sheriff’s Office

Jane Luxton, Pepper Hamilton

Ruben Barba, Laborers #67

Jennifer McNary, OLPPP, CDPH

Burt Olhiser, SSPC/PDCA

Frances Doherty, Doherty Restoration

Michael Ely, Janus, Corp

Walter Robinson, Laborers Union

Kevin Thompson, Cal/OSHA Reporter

Mark Carleson, Orange County

Karen Hipkins

SUMMARY

Background: The Division convened the advisory meeting after receiving a recommendation from the Occupational Health Branch of the California Department of Public Health (CDPH) to revise the medical surveillance requirements for lead, support of that recommendation from the Western occupational and Environmental Medical Association (WOEMA)and a follow up letter from CDPH to also consider other changes to the lead standards for general industry and construction. The Division asked Barbara Materna, Chief of the CDPH Occupational Health Branch (OHB), to summarize the need for revisions that were proposed. She explained that the recommendations had been developed by OHB’sOccupational Lead Poisoning Prevention Program (OLPPP) which administers the state’s adult blood lead registry, and that OHB has a mandate in the Labor Code to make health-based recommendations for occupational standards. Dr. Materna explained that the existing general industry and construction lead standardsare based on pre-1978 data on the toxic effects of lead exposure. Since that time, researchers have established a body of research showing that there are significant adverse biological effects at much lower blood lead levels (BLLs). In the 1-40 ug/dL range, the effects include: increased blood pressure, decreased cognitive function, impaired kidney function, increased risk of spontaneous abortion, and harm to the fetus. On this basis, OLPPP proposed extensive changes to the lead standard beyond what had been provided for the meeting today. However, additional recommendations for changes in the Permissible Exposure Limit (PEL) and Action Level (AL) will be made, based on an analysis using a pharmacokinetic model that is being prepared for OLPPP by the Cal/EPA Office of Environmental Health Hazard Assessment (OEHHA) and is due soon. Some of the changes in the medical surveillance section that OLPPP proposed to the Division are different from the Division’s proposal for this meeting in these critical areas: OLPPP recommends that medical removal should occur at one BLL of 30 ug/dL or higher, or 2 BLLs at or above 20; the frequency of BLL monitoring should be increased;and that medical surveillance should be provided to lead-exposed workerswithout an being triggered by air monitoring results. OLPPP proposed the revisions to the standards with the underlying goal of keeping sustained BLLs among occupationally exposed adults to below 10, and pregnant women to below 5.

Dr. Michael Kosnett added that adults with a BLL greater than 10 had a 55% increased risk of death from cardiovascular disease compared to those with BLLs of less than 5, and cardiovascular death is the leading cause of death in the US.

Dr. Papanek representing WOEMA concurred that two at 30 was not sufficiently protective. He also suggested that follow-up (confirmatory) BLL tests should be required within 48 hours (rather than the current two weeks) and that the trigger for BLL testing should be changed.

There was a general discussion of the ability of employers to meet the OHB proposal of one at 30 or two at 20. A lead abatement contractor and painting contractor said they felt that was acceptable. Consultants for heavy construction and a battery recycling industry representative were not sure that those industries could comply. B. Materna noted that in 2009, none of the heavy construction employers reported a BLL over 19. She noted that based on registry data, adopting one at 30 would have added 130 workers in the state to the removal number and two at 20 would have added no more than 374 (i.e., 374 additional workers had at least one BLL in the 20-29 range. She also noted that,based on past OLPPP studies, the industry with the highest compliance with the BLL testing requirement was battery manufacturingwhere an estimated 87% of the employers in the state were providing testing.

ZPP summary: the ZPP test had been in the proposed changes primarily to have the regulation retain the status of being at least as effective as the current Federal regulations. However, stakeholders noted that this test is more expensive than the blood lead test itself and preferred that it not be required. Physicians believed that it should not be required since it provides little useful information when BLLs are kept below 25. Since ZPP level generally lags behind the lead level by up to four weeks, it can occasionally be helpful in distinguishing a case of recent acute exposure. Consequently the draft will be amended to make it a discretionary test decided by the physician, and this would be reviewed by Federal OSHA.

Medical Issues related to removal: Other issues were raised including what level to apply to removal, with the general concurrence that one at 30 or two at 20 would be the revised proposal. There was support for having consistent language in the general industry and construction standards, including the same removal levels. There was general agreement that a medical exam should be offered when a blood level of 20 is found, and that it should be within four weeks of that test. There was also a recommendation to have a medical evaluation before the removal level is reached, but there was no general agreement as to what level should trigger that. OLPPP recommended there should also be a baseline and annual medical assessment, including a screening questionnaire that could be done in a manner similar to the medical appraisal for the use of respirators that is required by Section 5144; the existence of certain conditions could trigger counseling on the hazards of lead or testing as determined by a physician or PLHCP; OLPPP also recommended an annual blood pressure test. Another issue raised was that of employees who have chronically high blood lead levels who currently are not removed under the existing removal requirements but would have to be removed under the proposed requirements. The defining characteristics however were not identified. The OEHHA analysis should provide some of that information to estimate how long it would take for BLLs of employees with many years of high exposure to drop after placement on medical removal. Consequently, the current recommendation is for an annual exam to be given if the employee’s BLL is 20 or higher.

Allowable exposure during removal. There was extensive discussion of what exposure limits there should be for an employee with high BLLs who has been removed. There was general agreement that the person should not be exposed to lead at the current action levelsince that would prolong the elevated blood lead condition. One option is to establish a de minimis exposure area, that would have to be defined, where the known exposure is none or very low. The area could be defined as an area where lead is not used or very infrequently used or where unprotected employees have BLLs of 5 or less. Concern was expressed that this would entail extra monitoring of one sort or another. This will be examined further when OEHHA provides DPH with its analysis.

Other CDPH changes proposed for the general industry standard. Barbara Materna presented the other proposed changes for Section 5198. These include:

1: Work clothing. The employer would provide clothing at the Action Level. This should result in more workers protected and reduce take home exposures.

2. Trigger the most basic hygiene practices (prohibiting eating/drinking/smoking, providing a clean eating area) at a de minimus level, i.e., where lead is used/disturbed.. Many cases we see are due to poor hygiene practices. Add a new requirement for wipe testing in clean areas like lunchrooms.

3 Quarterly refresher training in addition to annual training.

4. Warning Signs at the de minimus level with the idea that the exposure at that level would be high enough to be an ingestion risk.

5. Recommendations for the Construction standard will be forthcoming.

Concern was expressed about added training because of the burdensome records and scheduling for larger employers like local government. Construction employers were less concerned since the requirement would be like a tailgate session. Other concerns were that the engineering controls might be considered to be less important for controlling airborne lead levels.

Finally there was discussion as to how to proceed with rulemaking; to start on medical removal or to wait for changing both entire standards. There was no consensus on this point. Attendees were told that there would be more proposed revisions sent to them as a result of the meeting, and after the proposals are received from OHB.

DETAILED MINUTES

Bob Nakamura welcomed the attendees and thanked them for coming to the meeting, reviewed logistics of the facility. He explained that the background for this meeting is that it is a process we are revisiting from almost 20 years ago. The basis for reconvening is to discuss whether or not the current regulatory removal level is too high, and other issues with the lead standards. At the time the lead advisory committee last met, some of the facts at issue were considered too new and unsubstantiated at that time to be relied upon to change the standard. Since that time, research continued about the effects that were reported then, and it seems that the majority of the research supports the need to make a reassessment.

Part of our job is to consider possible standard changes and we have to keep a complete record of what we discuss. Unless there are any objections I’m going to record the meeting. [There were no objections to recording the meeting; the tape recorder was turned on. The Cal/OSHA representatives introduced themselves]

Steve Smith and Bob Nakamura, co-chairs for the Division opened the meeting with introductions, reason for the advisory meeting, and background information. They then asked Barbara Materna, OHB Chief, to give an overview of their guidance document and their request to update the lead standard.

Barbara Materna commended Cal/OSHA for taking the step to open this process and asked to hear from the many people with considerable expertise in the audience. The Occupational Lead Poisoning Prevention Program (OLPPP) in the Occupational Health Branch (OHB) is a comprehensive program in CDPH in place for 20 years, with a multi-disciplinary staff. OLPPP administers the adult blood lead registry of California adults with elevated blood lead levels. OLPPP also investigates cases of lead poisoning among workers and their family members and provides education and technical assistance to individuals and employers and Cal/OSHA. They have assembled data on the biological effects of lead exposure. Part of the mandate of OHB is to make recommendations to Cal/OSHA about health standards. Through our OLPPP, we are also part of a network of 41 states with blood lead registries, called the ABLES(adult blood lead epidemiology and surveillance) program,and funded by the National Institute of Occupational Safety and Eealth (NIOSH).

Medical, toxicological and epidemiological data prior to 1978 is the basis for the current lead standards. The standards’ exposure limits are aimed at preventing acute toxic effects from very high blood lead levels. Over time, methods of analysis used in lead research have improved greatly including the use of x-ray fluorescence to measure lead in bones. Average blood lead levels (BLL) are today lower in the general population than in the pre-1978 years, and we can observe lower level exposure effects. More accurate and better studies and analyses are available. Now we have a body of evidence that demonstrates adverse biological effects at much lower BLLs. ABLES programs were concerned that even with this growing evidentiary body, the OSHA levels remain the same. In 2003 we convened, with Centers for Disease Control (CDC) assistance, an expert panel with 13 experts from industry and academia. This panel developed recommendations for medical management and prevention. The panel met numerous times over 2 years. We were unable to reach consensus as a group on a written document but 8 panel members met and wrote health-based guidelines that did not address feasibility issues. These guidelines were published in Environmental Health Perspectives in 2007 and as a CDPH recommendation in 2009. [The guidelines] conclude that there are a number of critical health endpoints at low BLL in the 1 to 40 range:

1. Lead has been found in many studies to result in increases in blood pressure, which is an indicator of risk for heart attack and stroke, representing a costly burden to society.

2. Cognitive function; there is a negative effect from a sustained elevated BLL, that is a decrease in brain function similar to increasing years of age; this can make it harder to think or to remember.

3. Kidney function is decreased, making it harder for the body to get rid of lead.

4. There is increased risk of spontaneous abortion at 5- 9 ug/dL.

5. Harm to the fetus. CDC recommendations to pregnant women are to maintain BLL below 5ug/dL.

6. Chronic exposure effects are more likely to be permanent than the acute exposure health effects occurring at the higher BLLs addressed by the current standard.

Our guidelines state the goal is to keep BLL below 10 for adults and below 5 for pregnant women and children. We have collaborated with WOEMA and our program has issued a hazard alert, and shifted our focus to make the dangers of these lower BLLs well known. Consistent with our mandate to recommend health standards, in Junewe made this recommendation to Cal/OSHA. You will see that there are differences between our recommendations and the ones proposed by Cal/OSHA for this meeting. I want to stress the most critical:

1. Lower the Medical Removal level; currently 50 µg/dl. Now we recommend 30 µg/dl for a single BLL or 20 µg/dl for two consecutive BLLs. Given what we know now, the old level is not protective.
2. Increase the frequency of BLL monitoring. Currently the requirement is for a baseline with a 6 month follow up. We propose more frequent monitoring for the first three months of exposure, then step back if the BLL is maintained at a low level. This will allow earlier addressing of exposures, before a worker reaches the removal level.
3. Revise the permissible exposure limit from 50 µg/m3. Set the limit to avoid worker harm. We haven’t made a recommendation for new PEL but we are working with OEHHA to develop a health based recommendation to come out soon. Currently the PEL is designed to keep most workers BLLs from exceeding 40 ug/dL which is too high.
4. Trigger med surveillance without air monitoring. Currently we have to have an airborne exposure over the action level of 30 µg/m3 before BLL testing is required. We are proposing BLL testing at the start of a job where lead is used or disturbed. We’ve tried to determine the current level of BLL testing among employers in some specific lead industries. Except for battery manufacturers and recycling, BLL testing rates are low.In most industries air monitoring is not common. Air monitoring misses possible lead exposure through ingestion. If BLL testing were required in workplaces where lead is used or disturbed, regardless of air monitoring levels, the data would be available more quickly and would be more useful to prevent higher BLLs.

To conclude, based on current data we believe implementing these 4 recommendations is necessary to protect employees from material impairment of health.

Steve Smith commented that based upon the 2009 CDPH guidance document and support of the medical community such as WOEMA, the Division convened the advisory meeting today on the BLL and medical removal issue. The other recommendations from CDPH are still waiting for further information from OEHHA and not ready for the advisory process to consider proposed language at this time. At this point we think the medical surveillance question is the strongest point to go forward with. Barbara gave a similar presentation on the 2009 guidance recommendations to our overall Cal/OSHA Advisory Committee that was well-received.