Medicare bill closes needle safety gap

All public hospitals must now comply

A small section in the massive new Medicare law brings all hospitals into compliance with the bloodborne pathogens standard. State and local hospitals now will be subject to the same provisions — including the involvement of front-line health care workers — as other hospitals that fall under the purview of the U.S. Occupational Safety and Health Administration (OSHA).

OSHA does not have jurisdiction over public employers outside the federal government. State plan states must cover all employees, but public sector employees in some federal OSHA states remained without the protection of the bloodborne pathogens standard. (Some states, such as Texas and Georgia, adopted legislation to cover public employees.)

"This closes the gap of needle safety coverage and provides protection for those not covered by the Needlestick Safety and Prevention Act," says Jane Perry, MA, director of communications for the International Healthcare Worker Safety Center at the University of Virginia in Charlottesville. "We can now say that all U.S. health care workers are covered by the same standard."

Workers now will be able to have access to the exposure control plan at public hospitals, and those hospitals must update their plan annually to consider new technology. The provision will be implemented as of July 1, 2004.

"We think it’s significant that there will not be this second category of these people not covered by the OSHA bloodborne pathogens standard," says Bill Borwegen, MPH, health and safety director of the Service Employees International Union in Washington, DC.

He notes that many of the county- and state-run hospitals are located in inner cities. "The challenges these people face are probably greater than what the private-sector facilities are facing," he says.

It isn’t clear how the new provision will be enforced in those states, which include Alabama, Alaska, Arkansas, Colorado, Florida, Idaho, Illinois, Louisiana, Mississippi, Montana, North Dakota, Nebraska, South Dakota, and Wisconsin.

State and local employees still aren’t covered by the Occupational Safety and Health Act (OSH Act) which means OSHA cannot conduct inspections or issue citations. Instead, the provision would be enforced by the Centers for Medicare & Medicaid Services (CMS), which has never handled occupational health issues.

The new section of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 states that "in the case of hospitals that are not otherwise subject to the OSH Act, [they are] to comply with the Bloodborne Pathogens Standard under section 1910.1030." Employers are subject to fines equivalent to those in the bloodborne pathogens standard.

"We’re studying the act and finding out what we need to do to implement it," a CMS spokesperson said.

For some, it was a bright spot in an otherwise controversial bill. In Colorado, state Rep. Andrew Romanoff (D-Denver) had tried unsuccessfully a couple of years ago to convince the state legislature to require public-sector employers to comply with the needle safety provisions.

"The populations that public facilities serve are generally at higher risk for bloodborne pathogens than at private facilities," says Romanoff, who is the minority leader in the Colorado House of Representatives. "It didn’t make any sense in the world that you would protect employees at private facilities and not at public facilities."

Romanoff’s staff used a questionnaire to gather information about practices at public hospitals.

"Our research said half of Colorado’s public hospitals and the state prison system were not using safer devices," he says.

Romanoff acknowledges that even without the measure, times were changing and needle safety was becoming more commonplace. "It’s been almost three years since my survey," he says. "Maybe these hospitals have decided voluntarily to come into compliance."

However, without pressure from unions or regulators, some hospitals have been slow to comply, says Barbara Coufal, legislative affairs specialist with the American Federation of State, County, and Municipal employees in Washington, DC. She notes that the provision had strong bipartisan support.

"We thought for something that's a life-and-death matter, that there ought to be a strong standard applied to all facilities," Coufal says. "By covering these public facilities under the OSHA protections, we accomplish that."