NACOSH Meeting                ) PRIVATE

                              )

Pages:  257 through 463

Place:  Washington, D.C.

Date:   September 15, 2010

IN THE UNITED STATES DEPARTMENT OF LABOR

OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION

NACOSH Meeting                )

                              )

			Auditorium

			200 Constitution Avenue, N.W.

			Washington, D.C.

			Wednesday,

			September 15, 2010

		APPEARANCES:

		Public Representatives:

		MICHAEL SILVERSTEIN, M.D., MPH

		Assistant Director

		Washington Division of Occupational Safety and

		  Health

		P.O. Box 44600

		Olympia, Washington  98504-4600

<PHONE_NUMBER>

		LINDA RAE MURRAY, MD, MPH

		Chief Medical Officer

		Cook County Department of Health

		5344 South Hyde Park Boulevard

		Chicago, Illinois  60615

<PHONE_NUMBER>

		ROY BUCHAN, Dr.Ph.D., MPH

		Colorado State University

		Occupational Health Section

		Department of Environmental & Radiological Health

		  Sciences

		5715 Pleasant Hill Lane

		Fort Collins, Colorado  80526

<PHONE_NUMBER>

APPEARANCES:  (Cont'd.)

		DENISE POUGET

		Assistant Fire - EMS Chief

		Alexandria Fire Department

		900 Second Street

		Alexandria, Virginia  22314

<PHONE_NUMBER>

		JOSEPH VAN HOUTEN, Ph.D.

		Senior Director, Worldwide EHS

		Johnson & Johnson

		410 George Street

		New Brunswick, New Jersey  08901

<PHONE_NUMBER>

		Health Representatives:

		TIMOTHY J. KEY, MD, MPH

		Key Occupational Health Solutions

		1414 Overlook Road

		Homewood, Alabama  35203

<PHONE_NUMBER>

		SUSAN RANDOLPH, MSN, RN, COHN-S, FAAOHN

		Clinical Assistant Professor

		Occupational Health Nursing Program

		University of North Carolina - Chapel Hill

		Gillings School of Global Public Health

		1700 Airport Road

		CB#7502

		Chapel Hill, North Carolina  27599-7502

<PHONE_NUMBER>

		Labor Representatives:

		WILLIAM BORWENGEN, MPH

		Director, Occupational Health and Safety

		Service Employees International Union

		CTW, CLC

		1800 Massachusetts Avenue, N.W.

		Washington, D.C.  20036

<PHONE_NUMBER>

APPEARANCES:  (Cont'd.)

		MARGARET SEMINARIO, M.S.

		Director, Safety and Health

		AFL-CIO

		815 Sixteenth Street, N.W.

		Washington, D.C.  20006

<PHONE_NUMBER>

		Safety Representatives:

		EMORY KNOWLES III, CSP, CIH

		Manager

		Industrial Hygiene and Safety

		Northrop Grumman

		7323 Avialion Boulevard, MS 1401

		Baltimore, Maryland  21290

<PHONE_NUMBER>

		PETER DOOLEY, M.S. CSP, CIH

		Labor Safe

		6301 N. Zeeb Road

		Dexter, Michigan  48130

<PHONE_NUMBER>

		Committee Contacts:

		DEBORAH PAGE CRAWFORD

		Designated Federal Officer

		Room N3641

<PHONE_NUMBER>

		VENETA CHATMON (Travel)

		Room N3657

<PHONE_NUMBER>

		SARAH J. SHORTALL

		Committee Counsel

		Room S4004

<PHONE_NUMBER>

		PAUL J. MIDDENDORF, PhD, CIH

		CDC/NIOSH

		Office of the Director

		4675 Columbia Parkway

		Cincinnati, Ohio  45226

<PHONE_NUMBER>

APPEARANCES   (Cont'd.)

		Committee Address:

		U.S. Department of Labor

		OSHA/Room N3641

		200 Constitution Avenue, N.W.

		Washington, D.C.  20210

	P R O C E E D I N G S

	(8:37 a.m.)

		MR. SILVERSTEIN:  I want to call to order today's meeting of the
National Advisory Committee on Occupational Safety and Health.  We are
missing one member, Denise, who should arrive a little bit later, but we
have a quorum, and I would like to begin.  We're joined this morning, as
you can see, by Dr. David Michaels, who is at the table, but is going
to essentially listen to the first hour as we recap some of what we did
yesterday, although he clearly is more than welcome to join in at any
point that he feels compelled to do so.  We would welcome that, David.

		Let me -- I did some thinking about where we are last night, and I
wanted to share that with you to get started, and I hope this will be
useful.  We've had as a -- at least since I've been chair, we have had
as a committee -- so the committee in this formulation has had now two
full days of meetings, and we've been exposed to a pretty wide range of
issues that are of concern to the agencies, as well as to each other.
And I think it was inevitable that a good amount of our energy in these
two days was captured by issues related to the Gulf oil spill.

		I think that NACOSH responded pretty well in getting some
recommendations to OSHA and NIOSH almost immediately that we heard
yesterday were well received by the agencies and were useful.  And I
think we heard yesterday that the agencies themselves responded quite
well to the crisis, even with the limited authority that they've been
given.

		Now, we've got a need to focus on some other things.  We can't let go
of the Gulf oil-related issues, but we do need to focus more sharply on
at least some of the other matters that have been brought to our
attention.  And there were two potentially promising concepts that we
put on the table late in the day that I think both could be
characterized as strategic and high level concepts, yet would seem to
allow the flexibility to address specific subjects over a period of
time.

		So these may be concepts that could carry us through for an extended
period of time, but would be adaptable to particular issues as the need
or the interest arose.  So we might avoid the need to set up a special
workgroup every time a particular topic came up.

		Today, this morning, what I would like to do in the next hour is to
see if we can sharpen these concepts and make them work, or in the
alternative decide that they're really not that promising and that they
should be set aside.  And, of course, this early discussion will be
subject to the conversation that we'll have with Michaels after we do
this recap.

		By the end of the day, I would like to have two workgroups established
with one or two specific assignments that would fall under each one of
them, and some plans for how we would continue to put some effort in
during the interim so that we don't just function on a quarterly basis
without work in between.

		So here are the two concepts that were on the table.  And I may not
yet be able to articulate these in the most artful way, but I think it
gets us in the ballpark, and then we can go from there.  The first
concept or issue would be this:  what can the agencies NIOSH and OSHA do
to better deploy their resources in a way that really matches the most
pressing worker protection and workplace safety and health needs in the
country?

		Under that kind of umbrella, there can be a number of more specific
questions that can be addressed.  You know, are there important gaps
that should be filled on a priority basis?  Are there things that we're,
as a nation, ignoring that are really pressing, worker protection needs?
 Are the agencies adequately anticipating the future?  Are there
strategic plans that the agencies have anticipating the future?  Are the
agencies or NIOSH and OSHA coordinating resources so that with limited
resources, they're functioning at a most efficient and effective way
possible?

		So there are a variety of questions sort of under that general
umbrella about strategic planning and deployment of scarce resources.

		The second broad concept would be how can the agencies more
effectively draw the nation's attention to worker protection.  The
specific issue that we were discussing yesterday in this area was how
can we ensure that worker protections gets sufficiently high priority
during emergencies such as the Gulf oil spill.  And a subset of that had
to do with the way that the agencies are currently annexed in the
national priority plan, whether or not there is something that we could
suggest to the agencies that would help to establish an arrangement in
which the agencies were triggered into action in a more effective way.

		Then there are a variety of specific questions that or specific issues
that we talked about yesterday, I think, that could fall under either
one of these umbrellas.  So that's sort of where we arrived yesterday,
with an agreement that we would think about these overnight, come back
and have this discussion this morning, and then talk with Dr. Michaels
and see where that took us.

		So I'm optimistic that by the end of the day, we can define a couple
of workgroups and kick a couple of specific subjects under each one of
those that will carry us through to the next meeting.

		So with that as an introduction, comments, suggestions, thoughts?
Yes, Roy.

		MR. BUCHAN:  Michael, I was thinking about this last night as well,
that you ordered us to do that.  And one thing we did not discuss very
much was the new initiative on injury and illness prevention.  That is
the essence of OSHA, in my opinion.  We don't know how far along that
program is, and I don't know if OSHA needs input there.  That's
something we would have to explore.  But I would be very happy to work
on something like that.

		I hate to add more to your list, but, you know, I was thinking about
OSHA in kind of a holistic fashion, and that is where they're supposed
to be with this new initiative, as far as I'm concerned.

		MR. SILVERSTEIN:  Joe.

		MR. VAN HOUTEN:  Michael, I gave it some thought as well.  And I agree
with both of your suggestions.  I kind of penned a phrase here that said
one of our functions should be to review strategic direction for OSHA
and NIOSH and advise on complex worker protection issues.  And an
example that came up yesterday were the protection of healthcare
workers.

		Now, I can think of three main areas of concern, from ergonomics to
infectious diseases to fatigue, you know, based on the latest
information in the media regarding concern by residents about fatigue in
a hospital setting.  And these are multifaceted issues.  So my opinion
is that I think the best use of time at these meetings would be to take
a deep dive into some of these topics, maybe schedule a half day
discussion, set it up with some key issues, and then debate them and
offer some advice on complex issues.  So I think that's the best use of
our time.

		Regarding worker protection getting higher priority, you know, just
some thoughts that crossed my mind.  I was really -- I mentioned this
article yesterday about the public attitude towards and experiences with
workplace safety by Tom Smith.  And it's really disturbing that the
public is not outraged about 5,000 deaths a year in the workplace.  It
just seems as though it is accepted by the general public.

		So I think we're fighting an uphill battle in that the public doesn't
really acknowledge this as a critical issue.  And it might be something
for NIOSH to look into.  What is the public perception regarding
workplace safety and why is there an acceptance of this many deaths?
And I don't even know what the exact number of disabling injuries is,
but it's certainly high each year.

		So I think all of those are worthy of the committee's attention, and I
think they are two good ideas.  Thanks.

		MR. SILVERSTEIN:  Linda.

		MS. MURRAY:  Well, I want to support these two broad buckets.
Obviously, it doesn't solve our problem because I would argue you could
fit anything in one of those two buckets.  So clearly those subgroups
are going to have to have some sense of priority that helps structure
the agenda.

		I think the key thing is that we know ahead of time, we know for the
next quarter, what we're going to look at, you know, early, and have an
ability to look at the exhibits.  Let me suggest this kind of division.
When I heard you talking, the first one, the matching resources with
need, that seems to me to be a profoundly internal to the field of
occupational health and safety bucket, which is fine.  And then
controversial questions like, you know, what is the appropriate
respiratory protection in a hospital setting, et cetera, we could, you
know, order those in some way and look at those.

		The second one -- and I like how you've expanded it from what we were
talking about yesterday -- is to me an externally directed group, which
is -- and let me suggest a priority within that first.  Let's start with
people that at least care about health.  You know, how do we convince
other people who are not specialists that health and safety is an
important mission?  And we've talked about emergency settings.

		We also talked about yesterday, which I think would fit under this --
we talked about the role of health and safety in a broad public health
use of health and information exchanges.  You know, that's really trying
to convince our colleagues in health care that there are some things you
need to look at.

		Other things that we haven't talked about, but let me just suggest,
the expansion of the Patient Care Act and the attempt to emphasize
primary care.  Again, how do we involve our primary care colleagues
around the country in preparing them to be able to recognize health and
safety issues.  How do we put that piece in the regulatory accreditation
processes for hospitals?  Most of the federal health centers now, for
example, are a joint commission, JCAHO accredited.  So how do we make
sure there is some stuff there?  You know, how do we beef up those
accrediting agencies where healthcare workers work to make sure that
these health and safety issues are part of the accreditation process.

		So I could imagine an agenda that looked at that.  So I would argue
these two buckets are reasonable, but that we have to sub-prioritize
within the buckets.  And I think the key thing we need to do, and we
could do this in conjunction with the agencies, is to, you know, look
forward 9 months, 12  months, and sort of order our discussions so that
we don't -- just to come here and hear everything at once and then try
to react at once.

		MR. SILVERSTEIN:  Okay.  I would agree with that, Linda.  Who else?
Peter.

		MR. DOOLEY:  Yeah.  Just not to add to the list too much, but the
other concept that we did talk about yesterday was this issue about
worker rights, sort of a broader look at worker rights, whether it is
involved in the injury and illness prevention programs, or the whistle
blower protection, the need for revisions and, you know, sort of
rewriting that.  Because, I mean, one of the things that I think is
really sort of very apparent in a lot of -- and I appreciate the
agency's programs that have really reached out to and tried to address
worker rights, and including workers, yet on the other side the
environment that we're in, in terms of the economic environment and the
whole doing more with less, has really prevented a lot of workers from
participating in health and safety in the way that they might have done
20 years ago.

		So I think that that's going to need to have some advocates and some
discussion so that we can keep on raising those issues, and helping the
agency do what they are wanting to do in that area.

		MR. SILVERSTEIN:  I'm hearing some support for having two groups at
that high level, with I think Linda's appropriate qualifier or notation
that almost anything can fit in one of the two, and that if it would be
useful to us as working tools, we have to have specific topics that
we're addressing.  I think this goes to Joe's idea of taking a deep dive
in each meeting into specific subjects.  And I would agree absolutely
that we have to plan long in advance.  We're going to need to ensure
that documents are prepared, that background information is available to
us so that we can study up before each meeting and use the time more
effectively.

		All right.  Other thoughts about this general approach?  Does it make
sense to people or are there some reservations about it?  Peg.

		MS. SEMINARIO:  I think the general approach is fine.  But just to
echo what Linda Rae said, I think we have to define at this meeting what
particular aspects of these two different groups are issues that we want
to, you know, get into.  And I would say keep in mind that our
responsibility here in the charter is to provide advice to the agency.
It's not just to have a broad discussion about occupational safety and
health.  And so I think that that's something that, you know, we could
have great discussion about the future of occupational safety and
health.

		But the charge and our responsibility is to provide advice to the
Secretaries of Labor and the Secretaries of HHS.  And so it does need to
be focused in direct ways that come back to their programs and their
responsibilities and initiatives.  And so that would just be a comment.
But within these two, I think the issue that we discussed yesterday, and
Peter just raised, looking at the whole issue of worker rights, that
that fits under this as well as far as this is a responsibility that is
covered under the statute, and what kinds of resources, priorities are
being, you know, put to that, and what kind of strategy exists around
that I think could be a topic within, say, you know, the first group,
and it could also be a part of group two because it has very much to do
with sort of externally here how do you push safety and health issues.

		One of the ways to push that is to have workers empowered to push it
forward.  So I think it could fit into both of these buckets.

		MR. SILVERSTEIN:  Thank you, Peg.  Susan.

		MS. RANDOLPH:  I would also agree.  I think the two broad categories
are good.  I like the fact that, as Linda pointed out, sort of internal
to the agencies and also external, which could apply to a variety of
different topics in the future.  As Peg was saying, that we need to be,
you know, mindful of what our charter is, looking at the advice that set
a firm time frame, so that for the next year or year and a half, or
whatever that time frame is, that this would be hopefully accomplished,
with some sound recommendations, advice I guess is the word, to both
agencies.

		MR. SILVERSTEIN:  Thank you.  Emory, did you --

		MR. KNOWLES:  Yeah.  One of the primary functions of the committee
that was already commented is to advise on the direction of the agency,
especially in the development of standards.  And we've discussed the
issue of resources in terms of both NIOSH and OSHA.  And I would
certainly urge continuation of the excellent relationship we're now
seeing between NIOSH and OSHA to move forward with the regulatory agenda
to develop new, enhanced standards.  So there has been a lot of
discussion on the healthcare worker issue.

		You know, one of things that certainly should be considered is perhaps
a vertical standard for healthcare workers.  NIOSH has an extensive
amount of research available.  OSHA has certainly looked at a lot of
these topics related to healthcare workers in the past.  Why not move
forward?  Why not develop a vertical standard?  If we have the
limitations on resources, why not move towards greater utilization and
draw up some national consensus standards in the regulatory context.

		So those are some other things that certainly should be considered
longer term.

		MR. SILVERSTEIN:  Thank you.  Other thoughts?

		MR. BORWENGEN:  Well, I agree with the approach.  Again, I think that
as I said yesterday, OSHA has scarce resources.  We need to figure out
how we allocate those resources in the most effective manner possible,
again in line with BLS statistics that illustrate where people are
getting hurt and injured.  And I guess if I had to name the first
committee, it would probably be, you know, not your father's Oldsmobile,
you know.  Of course, I don't even know if they make Oldsmobiles
anymore, so maybe that's not a good analogy.

		But I really feel like OSHA for too long has been stuck in an
industrial mindset.  I think they did a good job in those industries
when those industries were major parts of the U.S. economy.  They still
are, but they aren't what they used to be.  And as the economy has
shifted, I think OSHA needs to shift in kind, and I don't think they've
done a good job of doing that.  And there is a whole toolbox of
resources that OSHA has available to them, and we need to figure out how
we allocate those resources to attack the biggest health and safety
issues workers in this country face, and do it in a way that is
prioritized.

		MR. SILVERSTEIN:  I forgot to mention for the record that we were
joined a couple of minutes ago by Denise Pouget, who is now with us.
And so all the committee members who were here yesterday are present
today.  Other thoughts?  Denise.

		MS. POUGET:  I have to apologize for being late, but emergency
incidents are never convenient.  I came in late, so I'm not privy to all
the discussion.  But I know one of our tasks was to go and think last
night about, you know, where we're at.  And again, from a broad
perspective, I just kept thinking about some of the discussion and what
Dr. Murray had said about the emergency situations.

		Whatever the case may be, I think it just seems to come back to these
workers who are pulled in who are not emergency workers.  You know, we
tend to get on the right track maybe somewhere midstream, and that was
just a concern that we consider thinking about their health and safety
because, as I said yesterday, one day you're a fisher person, the next
day you're cleaning up hazardous materials, and you don't have any idea
what you're doing.  You only know you've got work, you know.

		So that was just one broad perspective from any kind of emergency.
You know, what are we doing to protect those people that we then pull in
to help clean up.  So that was just some of the thoughts I had last
night.

		MR. SILVERSTEIN:  Good.  Thank you.  Well, I think that given the way
that I structured this discussion, it's inevitable that we have on the
table already a whole grab bag of ideas, not all of which we can
possibly address, although we have some conceptual framework in which we
could fit any of them.  So we're only -- I think we're making progress,
but we're only part way there.  I mean, for the rest of the day, we have
to have the much more difficult discussion that removes items from the
table and allows us to focus on a few remaining ones.

		So I think it's still fine for awhile to put ideas on the table.  But
keep in mind that we're going to have to start taking them off as well.
So, Peg?

		MS. SEMINARIO:  One thing I think would be also useful to talk about
-- and I don't know if this is the appropriate time -- is some question
of what exactly we want these workgroups to do, and how do we envision
them functioning so that we have some idea of the level of activity,
work, exploration, work product, resources that are needed in terms of
agency resources, and figure out what is available to us before we leave
today.

		MR. SILVERSTEIN:  What thoughts do you have about that?  I mean,
you've had as much experience with NACOSH over the years as anybody has,
and you've seen it work well, and you've seen it work poorly.

		MS. SEMINARIO:  My experience has been that the workgroups -- the
workgroups that I've been on, they work.  They get into issues.  They
work closely with the agencies, staff.  I generally start out by being
briefed by the key agency staff who are involved in a particular area,
provided, you know, full -- the documents to get some background on what
it is, and then tried -- but also go into these workgroups with usually
some charge from the agency as to what is -- you know, what is the
question we're trying to answer?  We're just not trying to explore, you
know, something in general.  But what is the question that we're trying
to answer and the advice that we are trying to provide?

		So to have that defined beforehand so it ends up being something that
has a direction and a utility and it also timely for the agency.  But as
I said, it's important to get people sufficient background so you are
having a discussion about some concrete things rather than just your
opinions about things.  You get opinions later on, but have them be
informed opinions that have some relationship back to what is actually
going on, or else you end up with a real disjunction between the
activities, the discussions of the workgroup, and the agencies are here
and you're here, and that's not particularly useful for anyone.  And
then have some sense of what you think, having gotten into this, you
think the time frame is for the outcome.  And maybe there is a need for
the agency to have it done in a certain way.  So you structure your work
in that regard.

		So those are just some, you know, thoughts that I -- some experiences
in terms of dealing with it, and then coming out with a written product
at the end so there is something concrete that can be delivered.  It
doesn't have to -- sometimes they are very, very long reports.  NACOSH
was asked, just by way of example, in its early years to provide advice
to the agency on setting up all the system of benchmarking for
determining their required resources for state plans.

		NACOSH was developed to work with the agency to develop the first
cancer policy.  They drafted it.  NACOSH had extensive work done in the
whole area of hazard communication, this big hazard communication
workgroup.  We had a lengthy workgroup on injury and illness prevention
programs, so really getting into a lot of detail and meat of what the
agency's initiatives were.

		MR. SILVERSTEIN:  Okay.  I think that's very helpful.  There is no
doubt that all of us as committee members are going to have to be
prepared to do a lot of reading and a lot of study on these issues if
we're going to have the kind of products Betty is talking about.  Emory?

		MR. KNOWLES:  Yeah.  I have to concur with Peg.  I was involved in a
workgroup on the Hispanic worker outreach issue a few years back.  And
the way that evolved in the meeting, the agency alerted the committee
that there was an issue of high numbers of fatalities and injuries among
Hispanic workers in this country.  And so a subgroup was set up to look
at that task, to look at that problem.  Involvement with staff personnel
at the agencies took place.  There were many meetings and telephone
calls between the meetings on that issue.

		What ultimately evolved out of that was again, as you commented, a
written work product with specific recommendations that the agency and
the working group had all agreed upon prior to publication.  That was
published, and those measures were then implemented, and at follow-up
meetings, the actions taken by the agencies were reported back to
NACOSH.  And it was very, very effective.

		MR. SILVERSTEIN:  Okay.  Well, that's very helpful.  I think that it
probably makes sense for us to get into the discussion with Dr. Michaels
at this point.  Certainly, I think that the committee, under its charge,
could take on topics that the agencies are not interested in or would
rather ignore.  But I think we're going to be in much better shape if we
can address subjects that are of real importance to both of the
agencies.  And so we heard a lot from NIOSH yesterday.  We had some
discussion with OSHA.  And now we're looking forward to continuing that
with Dr. Michaels.

		So I hope this gives you some --

		DR. MICHAELS:  That's a wonderful transition.  Let me first thank you
all again for your service.  I know everyone here, you know, is more
than 100 percent occupied in their other jobs, and the fact that you
take the time off to come here and do this is something that I certainly
am very grateful for, and we appreciate your help.  And I also want to
thank the staff, Keith and Deborah and Sarah.  From the OSHA point of
view, I guess Paul, and Frank is not here -- NIOSH for your service
here.  It is very helpful.

		Let me apologize for not being here yesterday.  Needless to say, there
are several meetings every day I have to be at.  And yesterday I was at
the meeting with the OSHA review commission, and the judges --
unfortunately, it was in Charleston, South Carolina, and there is no way
to get there without spending the entire day doing it.  So even though I
only had a relatively small role -- maybe just --

		(Laughter)

		MR. SILVERSTEIN:  Just switch it with the other one.

		DR. MICHAELS:  Yeah.  Anyway, what was very interesting about that
meeting, among other things, was a little sense of how we're doing --
how the changes that we're making at OSHA and my vision are sort of
impacting out there.  And I heard a presentation from an attorney who
represents -- whose clients are employers who have some contact with
OSHA, usually people who we've issued citations.  And he said that he
felt uncomfortable saying that our new approach can be defined as
aggressive, but also very successful.  He particularly talked about our
-- what we sometimes talk about as regulation by shaming, and he used
that same phrase.  He said it's controversial, but he thought it was
being very successful, that when we issue a press release, we're very
specific about what we found from the employer, we put their name out
there, and we try to make it clear in the press what we found.

		In addition, as many of you know, for example, we try to approach
employers directly through letters, and we've done a letter campaign,
for example, after a number of really needless fatalities in the grain
handling industry.  And this attorney said that he is called by his
clients, who say, I saw this press release, I saw this letter.  What
should I do?  And, of course, he is able to say, well, fix their
hazards.  And that's exactly what we want to happen.

		The reason we do this, we send these letters out, we put out very
strong press releases, is we want employers to make changes before
workers are hurt.  And we want them to make the change before OSHA sends
inspectors because we have so few inspectors.  It's a way we leverage
our resources.  He was very complimentary.  I mean, it was nice for us
to hear that, that in fact, you know, taking OSHA public in this way,
making it clear what we're doing and what will happen if we find
hazards, is a very useful way to encourage employers to do the right
thing.  So I was very pleased about that.

		I know yesterday you talked a great deal about the Gulf.  And we're
eager to look at the lessons of the Gulf, and what we've learned there,
what we can do differently, what we can do better, what structures or
changes.  I appreciate your assistance on this.

		Certainly, one of the lessons we learned, which we see here as well,
is the importance of interagency collaboration.  And from the beginning,
we worked very closely with NIOSH, the National Institute for
Environmental and Health Sciences, and the Environmental Protection
Agency, as a sort of health subgroup.  And the Assistant Secretary for
Emergency Preparedness at HHS has sort of a health working group, and we
also as that group worked very closely with the Coast Guard and other
agencies as well.  And we hope to continue that through other -- in our
other activities.  And I know you heard from Dr. Howard yesterday about
some of the collaborative work that we're doing.

		Two of the issues that came up in the Gulf that come up on a regular
basis and, you know, as you discussed yesterday, are heat and fatigue.
And they're issues that we're again reminded that OSHA does not have
standards on these two very significant hazards.  And certainly we would
welcome your input into ways we could approach these issues.

		In terms of heat, the incident command there insisted, and we helped
enforce, use of a matrix that was put together by the military that said
given certain heat and humidity, this is the work schedule you should
use.  And that matrix is -- you know, it is used in a very standard way
in Iraq for our military personnel.  But it became somewhat
controversial to use it in the United States for workers who were in
many cases older, have disabilities, are certainly not as healthy as our
soldiers in Iraq, and therefore had much greater risk for heat-related
illness.

		But it was a very useful lesson for us to look at, and I think as a
result of the application of that matrix and many other requirements to
protect people from heat, I mean, ensuring that there were shaded areas
in the regular basis on all the staging areas, that there was plenty of
fluids for rehydration, that workers took these regular drinks.  There
was a medic on staff in certain conditions, just to check vital signs.
But even with that, we had hundreds of cases of heat -- we had signs of
heat illness, but we had relatively few cases of serious heat illness,
and we had no fatalities from heat, as far as we know.

		And there are fatalities from heat every summer in the United States
among farmworkers, construction workers, people working out of cell
towers, and so working in heat conditions often not as hot as where they
were in the Gulf.  So I think we learned a lot.  The question is what do
we do with that information.  How do we protect workers next summer, not
just in clean-up operations, but in all operations?  And we would love
your assistance on that.

		And similarly with fatigue.  We watched very carefully, we looked at
the literature, and we know that -- and we discussed this at our last
meeting, that in fact there is extensive literature that long work hours
have an effect on your ability to work safely.  You know, the operation
-- talking about operator error.  And there is no question after a
certain number of hours of work, you can't operate machinery as
effectively, can't protect yourself as effectively.

		I guess as Joe mentioned, we were petitioned by the organization
representing -- an organization representing medical residents and some
other groups as well to consider regulating the hours of medical
residents, who evidence has shown are at increased risk of lacerations,
needle sticks, and automobile accidents leaving work after working
extended hours.  And that again sort of raised this same issue.  But,
you know, this certainly isn't a problem unique to residents.

		There is a very larger employer, Alcoa, that has studied this pretty
carefully, and they do not allow workers to work more than 60 hours a
week.  They have seen through their own analyses of their own data that
actually in their case, they see in 64 hours a week the risk of injury
goes way up.

		So what should we do?  And this is an area again where we would love
your assistance on.  We're considering the petition for medical
residents, and we're looking at other information we have, where we
should decide what to do.  And that would be something we can certainly
use your assistance on.

		I know a few other areas that came up yesterday that we could
certainly -- we would be very grateful for your input.  In some ways,
one of the most pressing areas which I think we would like to address is
the question of injury tracking, injury surveillance, and incentive
programs.  They're all very much related.  As an epidemiologist, I know
that a great deal can be learned by studying patterns of injury, and
certainly by even looking at the individual instance in workplaces one
can learn a tremendous amount of information that is necessary to
prevent future injuries from occurring.

		Injuries that aren't examined, that aren't investigated, provide no
useful information.  From a public health point of view, it's an
abdication of responsibility.  When injury occurs, it's of fundamental
importance to find why it occurred so we can prevent them from occurring
in the future.  Sometimes you can investigate the individual injury.
Sometimes you have to look at the pattern of injuries to understand what
is going on.  But we know that there are tools to do that, and we know
that many leading employers understand this and do this.  Certainly, all
the employers in the VPP program are supposed to investigate not just
injuries, but near misses.  And those investigations should be
accomplished not just by the safety professionals, but involving the
workers as well, and the workers who are directly affected by it.

		And so we know this.  We'd like employers to ensure that injuries in
their workplaces are investigated.  In addition, injuries are very
important for OSHA to make decisions, to target our resources.
Certainly, we don't want to go to expend resources looking at workplaces
where injury risk is very low.  In fact, one of the ways we decide where
we're going to inspect is through our occupational data initiative,
where we ask employers, or we tell employers, in certain categories they
must send us the aggregate information from their OSHA logs, and within
that group, we look at the injury rate.  And among the highest -- the
employees with the highest injury rate -- we inspect a certain
percentage of those, you know, randomly chosen within that group.  And
we find that those inspections are quite productive.

		It's unfortunate that they're productive, but not surprising.
Employers with high injury rates are places we're likely to find a
significant number of violations.

		The program has its weaknesses.  We collect information at the end of
a year, you know, since an employer will aggregate their injury rates --
injury reports in February.  They'll send it to OSHA months later.  By
the time we actually use it to target an injury, it occurred a year and
a half or two years before the inspection takes place.  And that's
obviously a very long gap, and problematic.  But we still find it
useful.

		By law, we can collect more information if we want to, and we've held
a series of stakeholder -- we announced a few months ago a series of
stakeholder meetings to think about modernizing our injury and illness
information collection system.  And we're thinking about this very
actively.  We've had some very productive meetings.  But we'd love your
input into this.

		What information should we be collecting from employers?  What
information should be put on the web?  How quickly information should be
given to OSHA?  You know, some states, state plans, have very different
requirements than OSHA does, and what can we learn from those state
plans?  We know that California requires reporting all hospitalizations
and amputations to the California OSHA program.  We don't require that
now.  Should we do -- things like this we would be very interested in
your input and thinking about this issue.  We think there is a great
deal to be learned by OSHA, but also by employers.  So how do we set up
a system so employers and workers have access to that same information,
and they can use it in a timely manner?  And that would be something we
would be very grateful for you to think about with us.

		MR. BUCHAN:  Dr. Michaels, from your presentation, I think there is
one shortcoming, and that is how do you target health issues?  You were
talking amputations and injuries.  How do you target something like
silicosis that is going to have a relatively long latency period.

		DR. MICHAELS:  That's a great question.  And I would throw that back
at you in some ways.  I specifically don't say even though our
statistics all say injuries and illnesses, I don't say injuries and
illnesses because I know that the employer reports of illness are very
limited.  I mean, sometimes they're quite useful.  And I'll give you an
example.  We recently issues a citation for an employer where there four
cases of pneumoconiosis among -- in a workforce of less than 20 people.

		Now, this is a facility which dealt with slag from a coal-burning
power plant.  And so the slag was an amalgam of different materials, not
including carbon because the carbon was all burned off.  So you
certainly wouldn't call it Black Lung.  But there was a pneumoconiosis.
We didn't hear about any of those cases.  How should we hear about them?

		MS. SEMINARIO:  How did you get in there?

		DR. MICHAELS:  Well, we got in there -- the specific -- a complaint
led us there.  And several of those workers had left the workplace.
They eventually filed for worker's compensation.  But we didn't hear
about it from the worker's compensation system of Illinois, where we
should have.  I mean, it raises all -- this case raised all those
issues.  And looking at that, we'd love your thoughts on that, too.

		We should be working with health state departments.  I know NIOSH has
done a terrific job with various state health departments thinking about
reporting.  But the health departments often don't know.  Sometimes it's
the worker's compensation system.  Sometimes it's the employer, but many
times -- I mean, this is something employers really don't know in many
cases.  In this case, the employers heard about them because people left
work.  They applied for worker's comp.  And so they should have
certainly sent that information to someone.  I mean, we don't require
that right now to be sent to us.  It wasn't on their logs.

		Anyway, it's a great question, and that certainly is a piece of it.
But I specifically deal with injuries, but illnesses I would love to see
as well.  I just think it's a different answer.  And if you'd like to
take it on as well, that would be great.  But thanks for raising that.
Yes.

		MR. VAN HOUTEN:  Dr. Michaels, regarding injury and illness data
collection, you know, as you were speaking, the thought crossed my mind,
could we tap into the worker's comp system to get you data earlier.  So
is that an option or not?

		DR. MICHAELS:  Well, I mean, I think other people here have had more
experience with that than I do.

		MS. MURRAY:  This is a meaningful use example.

		DR. MICHAELS:  Yeah.

		MS. MURRAY:  So again, in theory, with the health information
exchanges, you know what medicine I'm on, what my blood pressure is.

		DR. MICHAELS:  Right.

		MS. MURRAY:  It's going to be there in the exchange.  So it's just
like, whatever it is, some mysterious lung disease.  If you have a
worker's comp case, and you have where those people work -- you said 20
employees, 4 people, you know, that should be a flag.  So this is what
is meant by active surveillance and paying attention to these health
information exchanges that we're investing millions of dollars in.

		DR. MICHAELS:  We cannot require the worker's compensation system to
provide us with information.  By law, it's my understanding that we
can't require them to.  On the other hand, there is no reason to think
we couldn't work with them to get more information.  I think there are
some states where it is probably easier than others.  I suspect the
Washington state system has a --

		MR. SILVERSTEIN:  We do have a unique arrangement in which we have the
equivalent of OSHA and NIOSH and the worker's compensation system all in
one agency, and we have been trying for years to take advantage of that
rather unique access to information.  And we do have some successes and
some failures that depending on where the committee goes may be worth
sharing in some detail.  I think --

		MS. MURRAY:  But the office of the national coordinator could require,
should they choose, that all HIEs that would be approved would have to
include worker's compensation data, for example.

		DR. MICHAELS:  No.  I think that's a very important issue.  And then
we know that worker's compensation reports for illnesses are not
particularly good.  And they're certainly better than the OSHA logs.
But they also are not complete because there are lots of -- we have to
think about this certainly much more comprehensively.

		MR. SILVERSTEIN:  Well, you know, if we're interested in examining the
match between resources and needs, this is an important area because we
know there are roughly 5,000 deaths a year from workplace injuries.  We
also know from the epidemiologic literature and other sources that there
are maybe ten times as many deaths from workplace illnesses, but they're
beneath the radar.  And the agencies spend very little of their
resources on -- they spend a disproportionate amount of resources to
deal with those illnesses and those deaths.  So it is an important area.

		DR. MICHAELS:  On the other hand, from the OSHA point of view, we're
less interested in the cases with very long latent periods because we
need to be able to make the information now.  On the other hand, there
is no shortage of cases we miss of little or no latency.  So how do we
get to those cases?  What do we do with them?  But that's an important
issue as well.  But I think that's one that NIOSH actually has worked a
great deal on, and probably one that before this group takes on would be
worth working closely with NIOSH and the various state health
departments that they have done.

		So I think in some ways that's a lower priority for OSHA right now.
Related to this, though, is the -- you know, I believe from the data --
well, let me step back.  We know that many workplace injuries do not
make it to employer logs.  We know that from many different pieces of
evidence.  But in some ways, the most compelling one -- and I don't know
if we talked about this at the last meeting -- is a recent study done by
the researchers at Michigan State University, Ken Rosen and his group,
trying to look at this question of the accuracy of the BLS estimates of
workplace injury.

		Now, as you know, the Bureau of Labor Statistics doesn't collect all
injury logs.  What they do is they take a statistical sample of
employers across the country in every industry or every SIC code,
however they do it.  And they ask for the OSHA log, and they enter it
into the computer, and they make estimates of the actual injury rate
based on that sample.  So when they say, you know, the injury rate is
4.7 per hundred, that's actually not a measure.  It's an estimate.

		And so the researchers at Michigan State said how many injuries are
getting -- you know, how accurate is that?  And so they chose to look at
traumatic amputations, traumatic amputations being the group of
workplace injuries that perhaps are the least controverted in that
someone loses a part of their body that includes a bone, cartilage, and
the case occurred at work.  And so based on BLS -- the BLS estimate was
that there were 170 traumatic amputations in the workplaces in Michigan
in 2007.  And so Michigan State contacted the state worker's
compensation system, and said how many amputations that occurred in 2007
were filed and paid for.  And then they contacted emergency rooms and
hospitals throughout the state.  And they found close to 800.

		Now, of those 800, some of them were probably self-employed
individuals, and some may have worked on farms.  There are various
reasons they may not have made the OSHA log.  But certainly we note
there is a big gap between reported injuries, injuries that actually
make it to logs, and injuries that occur.

		So we're trying to -- we've looked a little bit at why -- what is
happening here, and obviously there are some cases where employers
decide not to do that.  But I think an area that has been suggested as
being very important -- and we'd like to look at more, and we will now
try to collect some data on this -- is the role of incentive programs,
where peer pressure is used to discourage workers from reporting
injuries.  And the most classic example of that is the safety Bingo or
Friday afternoon pizza party.

		At our Latino worker health and safety summit in Houston, I talked
about this at a meeting, where I said, you know, commonly we see an
employer who said, if no one gets injured this week, we'll all share a
pizza on Friday afternoon.  And afterwards, one of the housekeeping
staff of that hotel who was listening in said, you know, we do that
here.  And so think about it.  Here is a woman whose job is to, you
know, make beds by herself, and using these heavy quilts.  And we know
that there is a lot of reported injuries in that group.  I don't believe
that the promise of a slice of pizza on Friday will impact the way she
works on Tuesday or Wednesday.  On the other hand, it will impact on
whether or not she reports an injury because if she does hurt her back,
I mean, it's not serious enough that she has to leave work, she will
herself feel, and feel from her friends, if she says something,
everybody is going to pay for it.

		And so there is peer pressure not to report the injury.  And, you
know, it's often that the prize is much greater than a slice of pizza.
It's often a raffle ticket for a pickup truck.  And so there is great
incentive for workers not to report injuries.  So we've made it very
clear that we are concerned about incentive programs because we think
that as a result of this, injuries are not reported.  And if injuries
are not reported, they can't be investigate.  And if we can't
investigate them, we can't prevent further injuries from occurring.  And
that minor injury that could have been reported and investigated could
have prevented something more major in the future.

		So while we think there are types of incentive programs that are very
useful and incentive programs that encourage people to find and evade
hazards, we think those are terrific, we've made clear, and I've made it
clear, for example, to companies in VPP, that I don't want to see those
-- the incentive programs that simply don't report injuries because I
think essentially what that does that is that discourages injured
workers from reporting injuries.  It doesn't encourage safe work.  And
there is an additional price to that.

		And so I'm very interested in talking this on because I'd love your
thoughts on how to pursue it.  We've discussed it now a little bit, but
obviously if you want to take this further, that would be great.

		MR. SILVERSTEIN:  Why don't we hear from Peg and Bill, and then take
it from there.  Bill?

		MR. BORWENGEN:  I don't understand why that wouldn't be a relatively
clearcut 11C violation.  I mean, basically, you're treating people who
are reporting injury in a disparate fashion.  They're not getting
something that other people are getting.  And it's discrimination.  I'm
not a lawyer, but, you know.

		DR. MICHAELS:  Nor am I, but --

		MR. BORWENGEN:  But I think a couple of test cases and a couple of
these press releases that you've talked about could really put a dent in
this.

		DR. MICHAELS:  Well, press releases are easy.  But what I'm told by
our solicitor is that if a worker reports an injury and then is excluded
from that raffle, that is an 11C violation.  But if the worker him or
herself choose not to report, that is not a -- the existence of that
program itself, unfortunately, is not an 11C violation, and that's the
problem.

		MR. SILVERSTEIN:  Peg?

		MS. SEMINARIO:  It is a problem.

		DR. MICHAELS:  Yeah.

		MS. SEMINARIO:  And it was an issue that was raised back in the
recordkeeping rule to make the practice a violation of the rule rather
than individual 11C violation.  And so I think in looking at the injury
and illness prevention program, that this is an opportunity to sort of
shift the orientation about what does an injury and illness prevention
program look like.

		There is a lot of activity going on right now at the same time, as you
know, in mining looking at these issues.  There is a lot of activity
going on right now in the rail industry.  There is a new advisory
committee that has just been set up in response to the metro incident
here in D.C. looking at safety management systems and trying to change
the culture in workplaces that would encourage people to report, and to
report near misses.

		Going home last Friday, I heard that CSX and a number of the rail
carriers are changing their practices now to basically try to change the
orientation from discrimination against people who report to advocating
reporting.  And this was actually an issue that came up at one of the
stakeholder meeting that I was at.  And what I would suggest is that
there is an opportunity at this point in time to try and make that
transformation in the occupational area through this rulemaking in
pulling in those experiences that are going on in other settings that
are dealing with the same problems.

		It came up, obviously, in the Gulf Coast.  It came up in Upper Big
Branch.  People were afraid to report, whether it was the hazards, the
injuries.  And what that, you know, presented was a whole of set of
circumstances that ended up being catastrophic.  In a lot of places, it
has not reached that level of catastrophe, but I would just say that
there is a different, I think, orientation that is going on and a shift
in looking at safety management systems than there was 10 years ago.  We
could take advantage of that and fully explore that in this rulemaking.

		MR. SILVERSTEIN:  Just incidentally, I was in a Simmons mattress plant
a couple of weeks ago, where workers are actually recognized and
rewarded for reporting close calls.

		MS. SEMINARIO:  Yes, change the incentives.

		DR. MICHAELS:  We would love to see that.  That's exactly right.

		MS. SEMINARIO:  But you have also -- again, I think in the injury and
illness prevention rule, there is an opportunity.  But you have to do it
as a matter of regulatory basis to change the practices.

		MR. SILVERSTEIN:  Linda.

		MS. MURRAY:  Well, it would be nice to have an employer that would do
the right thing, and I'm always glad when they do.  But I remind people
what we said yesterday.  We know computer-based, anonymous reporting of
problems and near-misses works.  So she mentioned the fire chiefs.  So
in healthcare, in the occupational healthcare setting, where the danger
of medication errors, where you make people sick or kill them, there is
a major disincentive to report.

		In a national hospital system that I served on the board, Catholic
hospital system, when we put in place an anonymous, computer-based
reporting mechanism for medication errors and near misses, it went up
fifteen-fold.  It was anonymous.  You know, you could make some
information so we could figure out, you know, the kinds of settings, et
cetera.  And it was computer.  It was in the company's intranet.  People
were confident that there would be no attempt to find out, you know, who
made the report.  It went up.

		So again, to mandate anonymous -- and especially with today's
workforce, the technology of today, to have anonymous, computer-based
reporting of problems and near misses, you will see the reports go up,
and then we'll have some tools that we can actually come in and prevent
things.

		DR. MICHAELS:  Who would you have them report to?

		MS. MURRAY:  Well, you know, personally I would have them report to
somebody who can actually do something.

		DR. MICHAELS:  But within the company, not to OSHA or the health
department.

		MS. MURRAY:  No.  I think that's up for debate.

		DR. MICHAELS:  Well, that's what I'm wondering.

		MS. MURRAY:  I think it could be mirrored, and I think we should look
at that.  You know, I have subjective feelings based on my history that
not all companies do the right thing.  So I'm always happy to have it go
outside of the company, in addition to inside.  Clearly, you want the
company to know about it, because hopefully they will do the right thing
and work with workers to make the place safer.  But as a backup, since
it's supposed to be reported anyway, you know, again, electronically
this doesn't become a problem.  It can go to both places
instantaneously, either a state agency or some other mechanism.

		But the point I'm trying to make is that we shouldn't be thinking of
old-fashioned systems of reporting in today's age, and we should really
look at the anonymous electronic reporting where we know in many, many
settings you get more accurate information.

		MR. SILVERSTEIN:  Peter.

		MR. DOOLEY:  Yeah.  Just a quick note about -- that the incentive
programs is one form of discouraging the bringing out, you know, the
hazards or the injuries or illnesses.  There are also other ways that
are in place in many workplaces that discourage reporting, which
includes discipline, drug testing, various ways.  And the newest -- the
latest thing that I've seen an explosion of in the last year or so is
these mandatory safety rules that are list -- that workers are required
to sign off on, which basically puts the burden of health and safety on
the worker, and then if they report an injury, of course, they have
violated one of those rules.

		So it's like, you know, a -- you know, it's a clear way in which
workers are going to be blamed for whatever gets reported.  So there is
a whole myriad of problems.

		DR. MICHAELS:  No.  We've seen that.  We've seen, you know, the one
strike and you're out --

		MR. DOOLEY:  Yeah, yeah.

		DR. MICHAELS:  -- all too often.  And we've actually also seen
programs that not only seems to be guaranteed firing the worker, but the
foreman as well, the supervisor, if that happens.

		MR. DOOLEY:  Big problem.

		DR. MICHAELS:  Yes.

		MR. SILVERSTEIN:  Well, this is a very rich area that we're discussing
right now, and it has a number of different facets to it.  It seems to
me that the thing that ties it together -- the question that ties it all
together that not only the agencies, but employers and unions are
wrestling with as well would be how do we use information systems to get
attention directed to the right places at the right times.  I know
that's something that in my agency we're actively working on.

		So I think this is an area where there may be sufficient interest on
the part of committee members, as well as interest on the part of the
agencies that might rise to the top of an agenda.

		DR. MICHAELS:  If I could just add one more complexity to this, I've
been meeting with a number of large construction contractors who are
very dedicated to safety, and do not have any incentive programs like
this.  In fact, when some of their companies that hire them insisted on
those, they report them to me, and we deal with them.  But their
concern, which I think is a very valid one, is if they ensure that every
injury is reported on the log, their injury rates are higher than
companies that discourage them.  And as a result of that, they're
penalized.

		In some cases, they can't get jobs with municipalities that look at
the rate as one of the things they do to issue contracts.  And we have
to think about that.  It's a complex issue because they're penalized for
doing the right thing.

		MR. SILVERSTEIN:  Well, I mean, the entire --

		DR. MICHAELS:  And we should again get to safety and health prevention
-- injury and illness prevention programs.  And what I tell -- as I've
met with purchasers of these large contracts, is to say don't look at
the injury and illness rate.  Look at the injury and illness prevent
program.  Look at the job safety analyses.  You want a robust program,
not just saying, you know, their injury rate is low because that -- but
there is a piece of it we really do have to deal with because we
certainly don't want to penalize the employers who do the right thing.

		MR. SILVERSTEIN:  Yeah.  Go ahead, Bill.

		MR. BORWENGEN:  We've been focusing way too long on this lagging
indicator.  I mean, you know, safety and health directors for companies,
you know, there is just way too much weight placed on this lagging
indicator as a benchmark for their performance.  And, you know, we need
to reverse that.  And this is an opportunity in the I2B2 rule to figure
out a way to incentivize reporting of near misses and near hits.  And
it's critical, and it's a great way to also involve -- you know, deal
with the need for greater worker involvement in the rule.

		So, I mean, we need to somehow convince folks we're trying to work
with here that relying on this indicator is -- I mean, because also, the
more we rely on this indicator, the more games that are going to be
played about, you know, reporting as a result.

		MR. SILVERSTEIN:  This discussion so far, I think, is really helpful
in understanding some of OSHA's needs.  Yesterday, when we heard from
the OSHA panel, there were some other things that were put on the table.
 Debbie Berkowitz talked about some of the recent enforcement activity,
the SEEP program, for example, the attempts to use letters with the
grain handling employers, and the utilities that are using gas purging.
We heard about where you are with the recordkeeping national assist
program.

		So we heard about a bunch of things in enforcement.  Mike Seymour
brought us up to date on the injury and illness prevention program
rulemaking, and Mandy Edens talked about where you are with the PELs
project.  I'm wondering if you could give the committee some indication
of your thoughts in these areas, and whether or not these are areas in
which you would really look to us for some advice, or if in some cases
you think that you've got enough stakeholder activity and other things
underway that we would be best advised to work on other things.

		DR. MICHAELS:  You know, we face the same dilemma that you do.  There
are so many different areas to work in, and we have to choose our
priorities and figure out to leverage our resources.  And frankly, I'm
worried that we're spread too thin already, taking on all these issues.
But they're all out there.  I do feel we need to address them.

		I think for some of the areas, we have -- we are already getting
streams of input, and certainly the PELs project we have an informal
group that we've been getting input from.  And one of the things we're
trying to do is actually to look beyond our immediate advisory group,
people we have regular contact with.  You know, in some ways, we're
trying to shift our substantive thinking.

		You know, the smartest people may not be in the room, and we're trying
to put the information out, or the questions out, more widely, using the
Internet and using some new tools, and see if we can get some different
inputs.  For example, around PELs, we had this request out saying, tell
us what chemicals you think we should take on and why.  And we've gotten
some very interesting input with looking at that.  And I think we plan
to do that with all of these areas, you know, think about reaching out
through electronic means to get input from other people.

		On the other hand, having a group like this, which is well balanced
and very thoughtful about occupational health, is very, very useful to
us.  And I think the big issues, which I think we could really use your
help on, are these -- you know, these connected issues of injury and
illness prevention program, injury reporting -- I mean, they are all the
fundamental basis for the relationship of employers, workers, and
safety, and then how OSHA relates to that.  And it's larger, obviously,
than just OSHA.  And that's what we need help on.

		We could figure out the best way to do a heat standard.  It would be
great to have your input.  But having you all sit down together and
think about really this core of tough issues is what I would love to see
more than anything else.  That would be most productive to us.

		In addition, you know, any additional thoughts you have about safety
and dangers, there are lots of things out there which obviously we'd
love to hear from you.  But in some ways, having you all together in the
room debating that may be less useful than taking on these core
questions of safety and health occurs in the workplace.  What is the
role of OSHA and NIOSH?  That is what I would love to see.

		MR. SILVERSTEIN:  That resonates with me.  I mean, since my job is the
same kind of job you have at a smaller scale --

		DR. MICHAELS:  It's the same job.

		MR. SILVERSTEIN:  I mean, that's exactly the thing that I'm wrestling
with every day.  So I understand the question you're suggesting.  Yeah,
Denise.

		MS. POUGET:  I believe in not reinventing the wheel.  And the
near-miss program that I spoke about yesterday is a program that reaches
across all -- not just one jurisdiction, but it's the International
Association of Fire Chiefs, firefighternearmiss.com, and obviously
firefighting is a very hazardous occupation and, you know, we're losing
so many firefighters every year for different reasons, line of duty
deaths.  And the long and short of it is, you know, this program was
based on what the FAA did years ago.

		I mean, I would love to, you know, offer to demonstrate it whenever
that is because I think it is a good starting point to at least look at
for a model because you're getting -- that particular agency, the
International Association of Fire Chiefs, runs this anonymous program,
and they do educational and cultural -- the need for cultural change and
so forth in the fire service.  And they're needs to be probably a
cultural change in the workplace, you know, making that work for all
walks of life.

		But it is an anonymous program, and its hold in the workers -- from
the workers' eyes, and they also give lessons learned.  And when you go
on, and you -- like, for example, we can search for, you know, house
fire incidents or highrise fire incidents or automobile accidents or
boating situations, whatever we want to look at, and we can, you know,
just go through.  And we use these lessons learned as kind of like
coffee table drills in all the firehouses.

		And that doesn't just take place in Alexandria or Montgomery County.
I mean, it's an international program.  So it's just a thought, since
we're discussing that.  And, I mean, as I was saying yesterday, you
could go to -- just an idea -- at osha.gov and file your anonymous
near-miss, and then you could have your database that way.

		But again, if that's an interest or something, I would be more than
happy to show it to you, or demonstrate it.  I could even do it today
because it's Internet based.  But, you know, whatever.  It's an offer.

		MR. SILVERSTEIN:  We may have time to think more about that.  Yes,
Emory.

		MR. KNOWLES:  Just to comment back on the issue of exposure levels.
You indicated that recently you've been canvassing various groups, you
know, which chemicals should be regulated.  Yesterday we heard that
there were probably about 15 chemicals that were being considered for
regulation.  And we all know -- you know, I've been on this committee
for a number of years.  I've been in the profession for a long time.

		The whole PEL process is broken.  It has been broken for years.  It
takes years to get new standards out.  Why isn't the agency aggressively
moving forward with approaches that have been used successfully by the
EPA, such as the implementation, or requirement of the implementation,
of best available control technologies when processes are being set up.
And similarly with the utilization of a technique that is used
throughout the world fairly successfully today, and that's control band.
 Why aren't we using control band?  That's a critical question.

		DR. MICHAELS:  Well, I think it very much relates to our law.  And I
think there may be some piece of that we can do from a regulatory point
of view, but it would be very difficult.  And without a change of
legislation -- Congress told the EPA they could use the best available
technology modeling.  That was actually -- my understanding is that was
done by Congress after evaluating the previous approach, which was much
more setting numerical standards.

		Congress hasn't given us that authority as much as some people would
like them to.  We are in the unfortunate position that we have to look
at each chemical individually and do a tremendous amount of work to
issue the regulation if we want to choose to regulate chemicals.  It's
certainly worth -- you know, if this group wants to take that on and
think about it, it would be useful.  But my thinking more is it would be
worthwhile to think about control of chemical exposures in workplaces as
part of an injury and illness prevention program, and say what should
employers do, what can we require of employers to do in terms of looking
at the available evidence.

		I mean, we have standards on a relatively small percentage of
chemicals used in the workplace.  And of those, many of them ought to
be.  But there is tremendous literature on those, and certainly many
employers, and certainly many of the chemical manufacturing firms,
recognize that our standards either don't exist or are irrelevant, and
they say in their product stewardship programs, this is how you have to
protect workers.  And they are far more protective than anything OSHA
requires.

		So how can we integrate that, we incorporate that, into the safety and
health programs of the companies that purchase these chemicals?  We need
to think about this in different ways, other than just issuing
regulations because we probably can't, unfortunately, issue that
regulation saying you have to use the best available technology, or that
you have to -- you know, here are the control bands, and when a chemical
is put in that band, you have to treat it in a certain way.

		We can't do either of those, it's my understanding, without some
legislative changes.  So given that, you know, we're stuck with what --
you know, we have to abide by these current -- our current situation.
So we've got to think about some imaginative ways to take that
information that's out there into account.  And that's an interesting
challenge we'd like to hear more on.

		MR. SILVERSTEIN:  You've given us a pretty strong suggestion to get
involved with the broad area of data systems, injury and illness
surveillance, the incentive programs that drive those, and how data is
used to direct resources.  On the other hand, you were pretty clear that
there are some subjects, like a standard for heat stress, that probably
are not -- don't really merit our attention.  With regard to the work
that you're doing on injury and illness prevention programs, we know
that you're doing a lot.  You've had a bunch of stakeholders meetings
with a lot of people engaged.  Can you talk a little bit more about that
and how you see that maybe fitting into the work that we're doing?

		DR. MICHAELS:  Well, you know, as I think everybody recognizes, the
basic idea of an injury and illness prevention program is one that many,
many groups within occupational health, from employers to unions to
professionals, embrace this.  But certainly I think each group probably
looks at it a little bit differently, and they have a different
understanding of what we're talking about.  And we've learned that in
our stakeholder meetings, where many different people stood up and said,
we think it's a great idea, but, or the devil is in the details.

		And so we have to weigh all this out.  And we have a long process from
the regulatory point of view.  Before we can issue a proposed rule, we
have to survey employers to what the costs will be, and we have to go
through a small business panel.  So we have a lot of opportunity to
between and the proposed rule to think about this.  And so we would love
your thoughts, thinking about what are the components, you know, in the
rule.  What should our requirements be?  You know, we can certainly --
we'd be happy to have someone like Mike Seymour or someone who is very
much involved in the process, if you put together a committee to work on
this, to meet with you.  We have notes from all of our -- we had four
stakeholder meetings.  They were very productive, and we certainly would
share this, to hear the issues that came up, and to have you thinking
about, you know, how we respond to these, what is important, what is
not.

		I mean, some of the issues that you've talked about this morning, how
do we incorporate that into a -- is it -- do we make that very specific,
just saying this is something that -- does the near-miss investigation
need to be described in detail?  I mean, all these things are important
issues.  And what do we learn in the past from this?  I know these are
areas that many people in this room have been deeply involved in for a
long time.  I mean, an injury and illness prevention program is not a
new idea.

		So we'd probably assign someone to work with you, and say, this is
where we are, this is what we've learned.  You're right.  We're not --
unfortunately, we're not at the point where anything is -- you know,
once we issue a proposed rule, then we have to essentially limit certain
discussions.  But we're not nearly at that point, so we'd love to get
input from this group and others as to what goes into that.

		MR. SILVERSTEIN:  Susan.

		MS. RANDOLPH:  You know, when Mike Seymour talked to us yesterday
about the I2P2, he talked about the importance of management commitment
and the employer responsibility.  I mean, that's I believe the crux of
that.  If you had good employer responsibility and commitment, that goes
along with the injury reporting and looking at near-misses and how can
we put the controls in place to prevent injuries and any exposures
taking place.

		Now, and I don't know what the best answer to get back to that
employer commitment, management commitment.  It almost has to be some
sort of a culture shift in the way of thinking.  You know, many
employers go along with that in looking at how can we look at all levels
of prevention and put things into place, and others, you know, don't.  I
don't know if some thought has been given to that whole area.

		DR. MICHAELS:  It's a tough one.  And obviously, you can't regulate
commitment.  So that's something we have to think about.  But, you know,
I don't want to give short shrift also to the reporting issue because
that's in some ways one that I think the occupational community has put
less thought into, into how injuries should be -- you know, what are the
best indicators to look at?  What injury information should be
aggregated?  What injury information should be public?  What injury
information should be sent to OSHA?

		There are 3 million workplace injuries reported in a year.  I'm not
sure OSHA would know what to do with 3 million injury reports a year.
So the question is what should OSHA receive.  What should be put on the
web?  There has been a great deal of research into the effectiveness of
posting of information in other areas and how that affects behavior, and
certainly behavioral economics is something that this administration is
very interested in looking further at.  Should we be requiring every
employer to post their injury rates on the web?  You know, there are
locations in Canada they do this for example.

		You know, lots of important questions that really -- that need to be
thought out some.  And we'd love your thoughts on that.

		MR. SILVERSTEIN:  Other questions for Dr. Michaels?

		MR. BUCHAN:  Dr. Michaels, how far along are you on the injury
prevention initiative?

		DR. MICHAELS:  Well, what I say is we have come what we think very
far.  But before we can issue a proposed rule, we have to go through a
number of steps that will take time.

		MR. BUCHAN:  Yeah.

		DR. MICHAELS:  So I think while we've thought a great deal about it
and have got a lot of input, we are months away, many months away, from
issuing a proposed standard because we have to do a survey, we have to
have a SBREFA panel.  And so given that, there is lots of time to think
more about what we would put into a proposed rule.  But we have a staff
that has worked on this actually for years.  But when I arrived, and I
said I think this is an important priority, many people who work at OSHA
said, we've been waiting for someone to come and tell us that.  We've
been working on this for years.  They're already -- in fact, I was given
a memo that was written 10 years to the date before I was given it
saying here are the various options.

		So OSHA has been thinking about this for a long time.  There was just
a period where it was very clear that wasn't an option that was proposed
on a regulatory basis, and that has changed.

		MR. BUCHAN:  Could we get a copy of it and maybe see if there are some
thing that should be included that are not, or advise not to have
something?

		DR. MICHAELS:  Well, I can't give you a copy of what we're proposing
as a rule.  That can't be showed outside the agency.  On the other hand,
the basic ideas I think are out there, and you can certainly comment on
them and get your -- you know, we'd love your input.

		MS. SHORTALL:  Could I add one thing about that?  When OSHA goes
through the SBREFA process, the materials that they will have to provide
to the panel will be made public, of which some form of what the
standard will require is in it.  Although they're not going to be asking
for your comment, the panel will allow anyone to comment.

		MR. SILVERSTEIN:  Well, I think Dr. Michaels offered just a little
while ago to share the information from the stakeholder meetings that
occurred.  The question for us is whether or not that's where we want to
direct our energies over the next few months.  And it is certainly
possible that that is to be decided later during the course of the day.

		MS. SHORTALL:  And I think Mr. Seymour said yesterday that all but one
of the stakeholder reports is already on OSHA's web.  So you can access
them already.

		MR. SILVERSTEIN:  Are there other topics that any of you as
individuals think is particularly important or that have come up in
discussion over yesterday or our previous meeting that you want to put
back on the table while Dr. Michaels is still with us?

		MR. VAN HOUTEN:  Just pursue the topic that Dr. Howard mentioned
yesterday.  I think in his presentation on influenza, he talked about
protection of healthcare workers.  So I'd be interested in
Dr. Michaels' viewing as to is this an area that we should be looking
at.

		DR. MICHAELS:  I think it's an area of great interest.  And certainly,
if you have the time to take on this as well, it's beyond that very top
priority that I talked about; certainly on we would love assistance on.
And we have a request for information out that we're gathering
information.  We are certainly looking very hard at how we can change
our regulations to protect healthcare workers, and we're interested in
looking at enforcement activities.  So I think any input you want to
give us on that would be fine.

		It's not at the top of the list for what I see this group is helping
us on, but it's certainly important to us, and I wouldn't want to
discourage you if you think you really have some expertise you want to
help us on.  That would be great.

		MR. SILVERSTEIN:  Bill.

		MR. BORWENGEN:  Yeah.  We were particularly concerned about, you know,
the impinging CDC guidelines that proposed to weaken the application of
respiratory protection in light of the fact that the differential
pathogenicity of this H1N1 virus and the way that the hospitalizations
and the fatalities are primarily among people under -- 95 percent of the
people are under the age of 65, which is the exact opposite of seasonal
influenza.

		So, you know, we've changed what was basically a disease of retired
individuals into a disease of working-age individuals.  And we thought
it placed a special burden on NIOSH and OSHA since if we do weaken these
protections, we still haven't gathered information, for instance, on a
number of clusters from last year among healthcare workers, and we're
concerned about the impact that is going to have in light of the fact
also that the H1N1 vaccine we've learned recently is only 62 percent
effective.  And so, you know, we're delegating millions of healthcare
workers, even if they got vaccinated, to not have sufficient protections
if these guidelines are weakened, which we believe they're going to be
because that's what the proposal was a couple of weeks ago.

		So, you know, I know that OSHA was enforcing the CDC guidelines, but
if they get weakened, we're concerned about what is going to happen to,
for instance, the pregnant healthcare worker who maybe even got
vaccinated, but the vaccine didn't work, and she is directed to go into
a room of a coughing H1N1 patient, and she asks for a respirator, and
they say, well, CDC says you don't have to have one.

		We're just trying to figure out, you know, what is the role for OSHA
in this situation, where, you know, it's a reasonable accommodation to
provide people with sufficient protection.

		DR. MICHAELS:  Well, again, I mean, if this is their -- I mean, I
think in terms of the utility, we certainly would like your advice on
all of these issues.  Again, I think this top issue is really sort of
the relationship across all workplaces.  But that's certainly an area if
you want to think about the issues of safety and health among hospital
workers, which is a very big area and one that we don't do enough.  But,
I mean, there are ergonomic issues that are very significant, and we do
a relatively small number of enforcement activities in hospitals.  There
are so few standards that are applicable.

		But when we're looking at vaccines, how should we be protecting
hospital workers?  Your advice certainly would be helpful in that.

		MR. SILVERSTEIN:  Yeah.  It's an area that touches many others.

		DR. MICHAELS:  Yes.

		MR. SILVERSTEIN:  I know that one of the areas that OSHA has been
especially interested in over the last several months and has been
mentioned a couple of times before this committee is the work that needs
to be done to address the needs of vulnerable and hard to reach workers.
 And I was wondering if you could tell us sort of where you are with
that and whether or not this an area that we ought to be paying some
attention to.

		DR. MICHAELS:  And it sounds like this is a group -- you know, I'm
sorry I didn't know about the work of this group before that reaches out
to Hispanic workers.  I think I should actually go back and read that
report.  This is obviously a very important area to OSHA.  Currently, we
are looking at ways to reach out to vulnerable populations using methods
that OSHA hasn't done before, reaching out to workers and many
faith-based groups, through other sorts of public mechanisms to tell
workers what their rights are and tell them that OSHA exists, to give
them some information and encourage them to call us because we know that
those workers are at great risk of injury and illness.

		We are putting a great deal of resources into that.  Following our
national summit, a lot of our regions and area offices are having their
own meetings with organizations primarily representing Latino workers or
Latino families.  We've had those in a couple of different regions
already, and a few more that are being planned.  I think it's very
exciting.  I think it's an important area to work in.  It's going to be
hard to evaluate our success.  We certainly can count the people we
reach, but how that impacts injury rates will be difficult to see.

		We're working very hard with our area offices to set up ways that they
can respond more quickly when they get complaints in languages other
than English, which has been a great challenge to us.  There are workers
who don't speak English we need to be able to contact.  So they need to
hear about OSHA.  But then once they know about OSHA and they're
encouraged to call, we have to be able to understand what they've told
us and to respond.

		So we're looking at various different ways to get translation services
and to get our information out in different languages.  Again, it's
probably an area where we have a great deal of work going on, and it's
probably not the most important area for this group.  It's a very
important area to OSHA, but it's probably not the most important area
for this group to work on.  On the other hand, again, if there are
individuals -- or if you think there are ways you can help us, we
welcome that.

		MR. SILVERSTEIN:  I appreciate the direct answer to that question.
That's very helpful.

		DR. MICHAELS:  Yeah.

		MR. SILVERSTEIN:  I notice, by the way, just incidentally, that a
number of the Susan Harwood grantees in this latest round are groups
that are not those who traditionally have received grant funds from
OSHA.

		DR. MICHAELS:  And then we should tell you that, you know, just
reaching out to people has a big impact.  There are a group of workers
from a Midwest meatpacking plant who drove to Houston because they heard
about this summit.  And at the meeting, we talked to them.  We gave them
a little card with OSHA's phone number and stuff like that, and they
gave them out at the workplace.  And the next day, one of the
supervisors said -- you know, someone has this card.  What's that?  He
said, it's OSHA.  Well, I guess we'd better have a safety meeting.  And
just the fact that people know about us and come to us, it begins to
have an impact.  And we want to reach out to workers and tell them, you
know, they have rights.

		MR. SILVERSTEIN:  Other topics you want to talk with Dr. Michaels
about right now?

		DR. MICHAELS:  And let me underscore here, just because I've said, you
know, it's not the top priority for us to get your input, that doesn't
we don't care about the issue.  Obviously, this is an issue we are
working very hard on.  But we're pretty far down the road, where there
are other areas where we're -- you know, which are complex, and we have
further to go, and we can probably use your assistance on.  And just as
we have to leverage OSHA's resources, we have to leverage yours, too.

		MR. SILVERSTEIN:  I appreciate that.  That's exactly what we need to
know.  So this is very useful.  Any other thoughts before we take a
short break?

		MS. SHORTALL:  I'm going to take care of one housekeeping item.  I'd
like to enter into the record as Exhibit .27 Dr. David Michaels'
statement to OSHA employees on "OSHA at 40:  New Challenges and New
Directions," dated July 19, 2010.

		MR. SILVERSTEIN:  Okay.  Thank you.  Anything else?  Dr. Michaels,
anything else for us?

		DR. MICHAELS:  No.  Thank you all again for your work, and I look
forward to your thoughts.  And I'll be meeting with you more this
afternoon, I think.

		MR. SILVERSTEIN:  Thank you.

		DR. MICHAELS:  Thank you.

		FEMALE VOICE:  Could you ask everybody to sign in?

		MR. SILVERSTEIN:  In the audience?

		FEMALE VOICE:  Yes.

		MR. SILVERSTEIN:  For those who are in the audience back there, I
would appreciate it if you would sign in.  There is a sign-up sheet in
the back.  We're a bit ahead of schedule, but I think this is a good
time to take a 15-minute break.

		(Whereupon, a brief recess was taken.)

		MR. SILVERSTEIN:  Okay.  Let's go back on the record, please.  Yes,
Sarah.

		MS. SHORTALL:  I'd like to mark as Exhibit .28 a letter from Dr. David
Michaels informing employers of hazards associated with cleaning fuel
gas piping systems and natural gas; as exhibit .29, a letter from Dr.
David Michaels to grain storage facility operators dated August 4, 2010;
as Exhibit .30, Dr. David Michaels' statement on long work hours and
fatigue and worker safety dated September 2, 2010.

		MR. SILVERSTEIN:  Thank you.  We're missing Bill, Susan, and Peter.  I
think we ought to just continue the discussions, even though they're not
in the room yet.  We're not going to make any decisions, so we don't
require a quorum for the next few minutes anyway.  Okay.  I'm told we
have a quorum anyway.

		I found that a very useful exchange with Dr. Michaels, and it should
be helpful to us in getting through the next few hours.  Dr. Michaels
and Frank Hearl from NIOSH are going to be back at about 2:45.  And I
hope that by that point we'll be able to tell them the direction we're
headed, and probably associated with that ask for some information that
will help us.

		I could just open it up for thoughts following the discussion with Dr.
Michaels.  Anything pressing based on the last conversation?

		MR. BUCHAN:  Based on what he was saying, it sounds like OSHA is going
to be targeting primarily injuries and not occupational disease.  Would
talking about having a group that would direct the agency more
effectively, given the resources that they have -- and I would really
like to participate on a subgroup that looked at that.  And my main
reason is that there are ways of targeting occupational health problems.
 And I just don't want to see occupational health dropped as an
important issue at OSHA.

		MR. SILVERSTEIN:  I appreciate that.  I think there would be pretty
widespread agreement with that.  It seems to me that insofar as we take
up Dr. Michaels' suggestion that we pay a lot of attention to the way
that information and data systems are used to drive attention and
resources, we will get into that area because part of the information
gap that we face has to do with workplace illnesses, and we've got to
fill that gap.

		We had started out the day by talking about two broad areas where we
might set up workgroups, and I want to come back to that and decide
whether or not that still seems like an appropriate way to proceed, or
if based on the discussion with Dr. Michaels that we need to modify
where we were earlier.  We had talked about one group or one area of
focus that would address the question of what the agencies can do to
better deploy resources and match resources with need.  And I think
Linda characterized that as being relatively internally focused.  And
the second area was the one of how the agencies can more effectively
draw attention to the priority needs or the needs of the nation to focus
on worker protection.  And that was characterized as more of an external
focus.

		Do those still make sense?  Yeah, Peg.

		MS. SEMINARIO:  Well, I guess I'm having a hard time trying to think
about the specific set of issues that Dr. Michaels talked about as far
as looking at an area of injury tracking, injury and illness programs,
injury incentive programs, incentive programs in the workplace, and how
that fits into -- I mean, it's a specific issue, and I don't know that
it falls neatly in either one of these.  But it's clearly one of the
things that is sort of at the center of a lot of his thinking, and a lot
of the agency's work that relates both to targeting enforcement,
changing culture behavior in the workplace.

		So I'm just having a hard time sort of matching in some respects what
he outlined as being some of where his particular priorities, the
agency's initiatives, with our broad frame.

		MR. SILVERSTEIN:  That's fine.  And I have got no pride of ownership
in this area, and I would have no particular problem jettisoning -- is
that the right word, jettisoning -- some of the prior thinking because I
think we got some good direction from Dr. Michaels, and we'd be
ill-advised not to pursue the line that he was suggesting.  And it does
not necessarily fit neatly into the other packages.

		Let's see if we can take a crack at articulating for ourselves what we
think Dr. Michaels was urging us to do.  Is that where you were going,
Peter?

		MR. DOOLEY:  Yeah, yeah, in the sense -- I mean, I was agreeing with
Peg in terms of what I heard from Dr. Michaels was a request for us to
help sorting out some of those issues about injury and illness
prevention standard and some of those -- all of the issues that are
connected with that proposal.  So I was going to suggest -- I mean, one
possible approach to this -- if that was perhaps the external -- the
number two that we have on our list, the external one, it may be an
issue that we could be dealing with as a full group when we meet.  And
then maybe the two committees would be the resources versus the need,
and this other one being working on the advising for the injury and
illness prevention program.  Because the only question I have about the
second one in terms of making health and safety a broader topic embraced
by the public, it seems like a very big issue.  And I think it's a
little bit outside of the scope of -- I think we can certainly be
contributing to it, but I think it is a huge -- it's a huge thing.

		MR. SILVERSTEIN:  I appreciate what you're saying, Peter.  It goes
back to what Peg said earlier today about our charge being to advise the
agencies on things they can and should do.  So you're point is well
taken.  But who feels capable of kind of articulating what you think Dr.
Michaels was getting at?  It has a lot of different facets to it, but is
there a relatively straightforward way we could articulate it?

		I can take a crack at it, and I don't know if this gets it or not.

		MR. VAN HOUTEN:  I can try.  I think I heard that he was asking for
our input and advice on new directions for injury tracking and
surveillance programs.  That's what I heard.  There were three points,
one dealing with heat, one dealing with fatigue, and the third one,
which he spent most of the time on, was injury tracking and surveillance
programs.

		MR. SILVERSTEIN:  Peg?

		MS. SEMINARIO:  But also, a piece of this, which isn't just injury
tracking and surveillance, has to do with the whole reporting of
injuries in the workplace, and the whole injury -- you know, the safety
and health incentive programs, which is what I think trying to figure
and look at that as a piece of a problem with respect to injury
reporting.  And again, that is something that also relates back to the
injury and illness prevention program, but also issues of recordkeeping
and also issues of looking at other sources of information.

		So I think what he was looking at were numbers of things that any one
of them has a lot of, you know, a lot of meat to it.  But I think that
what they're going to have to be grappling with in the injury and
illness prevention program and in all of these areas here is how do you
-- you know, what are the incentives for safety and health.  What are
the incentives for reporting, and not just reporting of injuries, but
reporting of hazards.  And I think looking at that whole issue is one
that would be important.  And the agency really, as you said, needs help
on that.  And as was said earlier, there is work on this.  I think
looking at the work that is going on in this area in other quarters is a
service that this committee, this subgroup, could provide assistance to
OSHA.  I mean look beyond just the walls of the agency in looking at
this, but as Denise would say, there is work going on in this area
amongst the fire departments.  There is work going on in this area
amongst FAA, amongst some of the others to try to get some handle and be
a conduit for providing some of that information to the agency I think
would be helpful.

		MR. VAN HOUTEN:  Yeah.  I think there is issues around timeliness of
data as well as accuracy of data.

		MS. SEMINARIO:  Yes, right.

		MS. RANDOLPH:  And then you would have access to that for employers
and employees.

		MR. SILVERSTEIN:  How about this?  You might characterize the question
as how do -- how should -- I'm struggling with the word "we."  Let me
use a different kind of grammar.  I think that the area that he was
putting in front of us was the design and the use of information systems
and data on injuries, illnesses, and exposures, to drive policy
decisions and deploy resources most effectively.  And that would include
things like -- if you frame it that way, it would include things like
examining what are the incentives that are built into these systems, and
are those incentives driving behavior in the right way.

		Am I in the right ballpark?

		MR. KNOWLES:  I think you're in the right ballpark, but I think it
goes back to the fundamental question, and that is what is the data
going to be used for.  And if the data is going to be used for injury
and disease surveillance in order to identify programs and initiatives
to permit outreach to reduce the incidence of those, that's one
approach.  If the data is still going to be used for enforcement
initiatives, that's a whole different program.

		The use of what we put on OSHA logs to target industry companies for
enforcement intuitively leads to underreporting injuries and illnesses.

		FEMALE VOICE:  I agree.

		MR. KNOWLES:  So it is a conundrum that you have, you know.  You
really kind of can't have it both ways.  But I think the way you worded
that, I think that's important to then delve in deeper and think about
it, you know, what is the intent of the use of the data.

		MR. SILVERSTEIN:  Keith.

		MR. GODDARD:  I just want to make you all aware of three stakeholder
meetings that we had on recordkeeping modernization.  The key moderator
of those meetings is going to be able to, you know, summarize and give
you his report.  There is another dimension that I'd add to you that Dr.
Michaels sort of alluded to.  What do we do with 3 million injury
instances records?  And we're struggling with something you alluded to,
Linda and Denise, a little bit with the near-miss thing.  What sort of
infrastructure do we need to handle this?  And it all tied very closely
to what are we going to use it for.

		FEMALE VOICE:  That's right.

		MR. SILVERSTEIN:  Linda?  Thank you.

		MS. MURRAY:  Well, it seems to me that how you frame it in all of the
discussions that -- first of all, this fits in both buckets.

		FEMALE VOICE:  Right, it does.

		MS. MURRAY:  And Michael mentioned -- but I want to remind us, NIOSH
has done a lot of work, and especially some partnership work, with
states around some of these things.  I would suggest -- this is not
going to be a solution because we'll have to further define what the two
groups might talk about.  I would suggest that we emphasize this for our
next meeting, and that we, you know, get the background materials, you
know, as early as possible, and that we allow subgroups -- I'm not quite
-- you know, it's further on today to sort of further tease out some of
these issues.

		I don't want to -- you know, I have some ideas, but clearly we're not
going to be able to cover everything.  But we can pick some careful
things to talk about and to raise questions in a coordinated way.  So I
think this is a reasonable thing to start with for our next meeting.
Like I said, I think it does -- can go in both buckets, but that we have
to sort of before the end of the day define it a little better so we
know which subgroups are going to work on which things.

		This might include -- I'm not saying it has to.  It might include
everything from looking at some of the state recording mechanisms that
NIOSH has been working on.  It might include bringing someone from the
ONC to talk about how meaningful use of how HIEs might, you know, be
able to link and compensate -- it can mean any number of things that the
subgroups could flesh out a little bit.  It might mean looking at
incentive programs and disincentive programs for reporting.

		So we could, hopefully before the end of the day, have a better notion
what might be on the agenda for the next meeting and how we would divide
it up.

		MR. SILVERSTEIN:  Denise.

		MS. POUGET:  Something came to mind as we were talking.  And again, I
go back to something that the fire service is doing as well.  And it's a
broad kind of spectrum for what they call firefighter life safety
initiatives to try to tackle the problem of all the firefighter deaths,
and of course, the injuries, but an enormous amount of deaths that we
experience every year.

		So what they did was they had a summit of all of the fire service
professionals and talked about this problem, and they came up with -- I
want to say it was 19 life safety initiatives.  And one of the
initiatives was a need for a cultural change in the fire service,
identify the need for a cultural change towards safety in the fire
service.  One was the national database, you know, identify the need for
reporting systems and so forth.  Another was establish proper incentive
programs.  And we were just talking about incentive programs, but they
can be good if you state what the boundaries are, where we don't become
discriminatory; ongoing training on the importance of injury reporting
to the employees and the supervisors, what the supervisor's role is.

		So I'm just thinking maybe from -- I know our task is kind of broad.
So if we also thought about -- because what I'm hearing us all -- I've
heard us talk about cultural change today.  I've heard us talk about the
reporting systems.  I've heard us talk about training, incentive
programs.  Maybe one thing we can talk about doing is establishing
worker health and safety initiatives for OSHA, recommending to OSHA that
they establish, you know, training programs for supervisors, you know,
proper safety culture in the workplace, and what their role is as a
supervisor, and for people not to be afraid to report injuries, and kind
of steer, if you will, kind of along the same lines as what the National
Fallen Firefighters did.

		But that's just a thought.  I mean, we're talking about a lot of the
things -- you know, it's kind of ringing a bell.  But if we established
initiatives as a recommendation for this is what we believe needs to
occur in every workplace, that here is what employers should be doing,
and so forth, you know, maybe that would focus us a little bit better.

		MR. SILVERSTEIN:  Bill.

		MR. BUCHAN:  As far as surveillance goes --

		MR. SILVERSTEIN:  No.  Bill.

		MR. BUCHAN:  Oh, I'm sorry, Bill.

		MR. SILVERSTEIN:  We'll come back to you, Roy.

		MR. BORWENGEN:  I'm going to go back to Emory's comment.  I mean, you
wonder what impact -- you know, because it wasn't always the case where
OSHA required employers to mail in their OSHA -- the 100 logs to -- I
mean, so you think it's had a significant impact in promoting
underreporting, the fact that people now have to submit their logs?

		MR. KNOWLES:  No, I'm not saying it has had a significant impact.
What I'm saying is that if an employer has to report data, which is then
in turn used against that employer in targeting enforcement -- or as
someone mentioned earlier, in business, when you bid on a contract, and
you have to list your experience, log rates, and your OSHA incident
rate, or your lost work days rate, that becomes a disincentive for
reporting.

		MR. BORWENGEN:  Yeah.  I thought that was going to be the case from
day one.

		MR. KNOWLES:  Yeah.

		MR. BORWENGEN:  And I think that should somehow be de-linked, you
know?  And if we're trying to report again the reporting of near misses
or near hits, you know, maybe when OSHA cites an employer for a large
fine, instead of -- maybe reduce the fine and say, well, we'll reduce
the fine X dollars if you agree to set up a near-miss, a near-hit
program, you know.  I mean, to really try to set up some model programs
where we try to promote what Denise is talking about and others, to try
to change this culture.

		But I think we do -- this is a conundrum.  I think because OSHA has
such limited resources, they need to target the worst employers.  But
from day one, when I said, oh, you're going to -- once you start mailing
in those logs, we're going to start seeing people doing -- you know,
trying to reduce the reporting, and they're going to use incentive
programs to -- these disincentives to report are going to skyrocket, and
that seems to have happened, you know, with the safety bingo and
everything else we've talked about.

		But this injury and illness reporting is really at the crux, I think,
of what Dr. Michaels talked about earlier, and how do we decouple some
of these disincentives to report.  And I think this is one of them, I
think, that by linking this targeting to that, but it's the basis for
OSHA's targeting.  So it's a big issue.

		MR. KNOWLES:  There is one other side to it, too.  There are companies
today that are now setting up executive incentive plans based upon
performance to various environmental health and safety metrics.  So, you
know, there is discussion about employee incentive programs.  But also,
you have to keep in mind, there are management incentive programs in
this country that can create disincentives for recording data on
injuries and illnesses.

		MR. SILVERSTEIN:  Yeah.  I think you're right.  There are lots of
examples.  Roy had something to say.  And then I'm going to try to take
a crack at identifying at least some major areas of questions that I
think are on the table.

		MR. BUCHAN:  I think in terms of surveillance to help through
targeting, I'm certain that NIOSH has a lot of information that would be
very useful to OSHA.  Now, I don't know if they can share that
information with OSHA.  But the two agencies are working very closely
together right now.

		Another thing that NIOSH has that would be very useful that would take
a great deal of analysis are the health hazard evaluations.  And if you
took a look at that historically, maybe over the past three years, you
would be able to target certain industries that have health problems.

		MR. SILVERSTEIN:  Yeah.  I think you're right, Roy.  And I think that
we're in an area here that is equally applicable to both OSHA and NIOSH.
 They have very shared interests.  But as I'm listening, I'm hearing
three sets of questions that I think we might be able to address.  And
by doing so, I think that proposals or advice and recommendations to the
agency might become more clear.

		The first question would be how are our current workplace injury,
illness, and exposure data recordkeeping and surveillance systems
designed.  What are we doing right now, we in the broad sense?  What are
the agencies doing?  What are the requirements for employers?

		The second set of questions would be what are these systems currently
being used for.  What is the intent of them?  What could they be used
for?  What should they be used for?

		And then the third set of questions would be what are the incentives
and disincentives that are built into these systems right now that drive
behavior, either in ways that we approve of or ways that we think are
ill-advised?

		MALE VOICE:  That's a good summation.

		MR. SILVERSTEIN:  Peg.

		MS. SEMINARIO:  Well, so those are -- so that's sort of an exploration
of looking at the, you know, the what, right?  How are they designed?
What are they being used for?  What are the incentives and the
disincentives?  But to what end?  I mean, what should they be?  I mean,
the question really is what should, right?

		MR. SILVERSTEIN:  Yeah, right.

		MS. SEMINARIO:  Right.

		MR. SILVERSTEIN:  Again, what I said, the second question is what are
they being used for and what should they be used for.

		MS. SEMINARIO:  No.  But also incentives and disincentives here, how
do we change them?

		MR. SILVERSTEIN:  Oh, okay.

		MS. SEMINARIO:  That's what I'm just saying.

		MR. SILVERSTEIN:  Oh, oh, fine.

		MS. SEMINARIO:  But we've got to be thinking about how to -- you know,
what are the recommendations we are going to do, not just the findings,
right?  What are the recommendations to bring about the change.  And I
think, you know, that's really the focus.  We can do a lot of analysis
of what the current situation is.  But let's not get so focused on doing
such, you know, an in-depth review that we lose sight of the fact that
the point here is to look at how can they be improved and changed.

		And one other observation, just again from my other previous years on
NACOSH, that unfortunately, for whatever reasons, a lot of the workgroup
activity and a lot of the activity of the committee focused largely on
OSHA, and we probably neglected NIOSH.  And just to say that each of
these areas that we're working, I think we have to look at the role of
both agencies in terms of their involvement.  And, you know, in some
cases it will be a stronger OSHA role; in other areas it will be a
stronger NIOSH role, but not, you know, lose sight of that.  And as much
as we can, deal with them jointly because they do have joint
responsibilities.

		MR. BORWENGEN:  And to take advantage of a surveillance team at NIOSH,
which could probably be helping us in this area.

		MR. SILVERSTEIN:  Sarah?

		MS. SHORTALL:  I'm just going to, I think, reiterate something Ms.
Murray said that might give you an idea of coming up with
recommendations for all three.  And this will be the first one.  You
said that the first would be how are current recordkeeping systems
designed.  And then the thing would be, what information do they
collect, and what information should they collect.  And that was an
issue that Ms. Murray had brought up.  So that could yield
recommendations.

		MR. SILVERSTEIN:  Okay.  That's helpful.  Linda?

		MS. MURRAY:  I want us to be careful because we're not -- and I don't
think anyone is proposing -- I hope not -- that we become a study group
for this, okay?  We're an advisory group, which means in crude parlance
we get to shoot off at the mouth without a whole lot of -- you know, we
don't have to prove every point.  So to me, we don't -- of course, I
think we should have some overview of the data and all of these
questions.  But we don't have to have the definitive -- we can say you
two agencies should set up a process to definitively blah, blah, blah.

		So what we want to do is give direction and advice.  We're not the IOM
study group that looks at what is going on in health and safety data.
So I want to encourage -- because we want to try to help shape the work
and help have a discussion that allows agencies to sort of have a
different view of what is going on, and for them to move forward.  So in
that spirit, I'd like there to be questions, as long as we don't think,
you know, we've got to have a peer-review available, you know, set of
answers.

		And in that same spirit, I expect that many of our recommendations
will not be that detailed.  We might say something, we think we should
look at methods that do not discourage workers from reporting, for
example -- which is very different than saying here are ten things that
the two agencies need to do to address this.

		So I just want to make sure that we're clear.  To me, an advisory role
is more flexible and more fluid, and it raises questions.  It's not
trying to provide a recipe that the agencies should follow to solve
whatever problem they're talking about.

		MR. SILVERSTEIN:  I think that's fair.  I mean, there clearly is a
balance here.  We need to be making recommendations and providing advice
that's credible, and clearly represents some understanding.  But we
don't want to get paralyzed by the study that is going to be required.
I think we would all agree with that.

		Let me add a fourth question, which is more along the lines of what
Peg and I think Linda were just suggesting.  So the way we go is -- the
way we would proceed is this.  We would examine -- we would take some
time to do some reasonable level of examination of the first three
areas.  How are the current surveillance and data systems currently
designed?  Secondly, what are they being used for?  And third, what
incentives and disincentives are built into them?  But then the fourth
question would be -- and this would really be directed at the advice we
would construct for the agencies.  How can these systems be improved and
changed in order to better accomplish our ability to find and fix
hazards and protect worker rights?

		And so it would require us going through some period of examination,
study, gaining some knowledge about these systems, being able to
describe them, and then a much more active process of constructing some
advice and recommendations.  Does that feel like it's making sense?  I
mean, that feels like it's something that would be a bit charged for us
as an entire group.  But then we could break into some smaller groups to
kick off pieces of this.  I see Keith and then Peg and then Peter.

		MR. GODDARD:  Yeah.  That seems tangible from my perspective.  Maybe
the key point, you know, how are they designed, I could give you
something immediately to look at.  You know we've been collecting 80,000
elements for 15 years, with specific names and addresses.  Intuitively,
you'd think it would be a discouragement.  My sense is that the
regulatory oversight has prompted people to try to be correct because we
follow up when you end up on our inspection list.  It's a more thorough
review of your logs and you attempt to get it right because you can end
up on our SST inspection.  And those have been lucrative inspections
even though people know that we're collecting that information.

		So I'll share some of the historic background of what we've been
seeing on these 80,000 elements.  That's not BLS.  It is
establishment-specific.  It's what is going on at that street address at
that establishment.  So I can pull together for each question that we've
come up with.  It seems tangible that I could, once you get into a
smaller committee group and get down into the weeds and -- this isn't my
shop, you know,  And then I'll share some of that stuff with you on
surveillance data for 30 years of sampling that we've done.  I don't
know if you want to get into that.  That's a different shop, but it's
things that we -- I'll share with you, and you can decide what you want
to --

		MR. SILVERSTEIN:  All right.  Thank you.  I appreciate it.  We're
clearly going to have to make some data requests and avoid getting so
deep into the weeds that we never come back up for air.

		MR. GODDARD:  Yeah.

		MR. SILVERSTEIN:  I think it was Peg next, and then Peter.

		MS. SEMINARIO:  The other thing I would say is that as far as the
recommendations, I think with some of these recommendations -- and I'm
going back to -- you know, Bill is reminding me of how many other
endeavors the NAS committee -- injury and illness, recordkeeping,
reporting systems, the keystone discussions around this.  We also have
to look at sort of the level of the initiatives that we're recommending.
 And I would suggest that we look at things, not always sort of big
things, because you can come up with a whole, yeah, let's redo the
entire system here.  Well, that's probably not going to happen.

		And so I think we have to be sort of thoughtful in terms of our
recommendations, that they also be sort of concrete and tangible, and
sort of the steps of getting there, because with a lot of these things,
it's not going to be possible to do them all in one bite.  And to think
about how do they fit in to some of the agencies' initiatives, and so
what can they be doing in other things that they're working on to
implement these things.  And so just to be as concrete and tangible as
we can be.

		MR. SILVERSTEIN:  Yeah.  I agree with that, Peg.  And it's a good
caution for us to keep in mind as we get closer to making
recommendations.  We've got to avoid both ends of the spectrum.  If
we're so general and just say, OSHA should improve the incentives or
remove the disincentives, it's so general it's useless.  If we get down
to the detail of saying, well, there ought to be another column added to
the 300 log, then it becomes so specific, it can become almost trivial.

		So somewhere in the middle is where we're going to want to aim.
Peter?

		MR. DOOLEY:  Yeah.  Just to remind us in terms of the timetable of
various things -- and what I heard Dr. Michaels say regarding the injury
and illness prevention program, which can capture some of these issues
very significantly -- I mean, I heard sort of a -- you know, maybe six
-- you know, sort of saying that within the next six months or so, there
is this opportunity to have some input into that while they're going
through these other steps with the proposal.  And actually suggested --
I mean, he suggested Mike being a possible staff person to work with the
committee.

		I mean, it seemed to be very, very specific and very time -- you know,
sort of time needed in terms of, you know, getting going.  So I just
want to -- whatever we do, I mean, I think we need to sort of have that
be in -- sort of in play in terms of the plan.

		MR. SILVERSTEIN:  Okay.  Let me suggest that -- I think we're making
real progress.  Let me suggest that we set this aside for a few minutes
and address one other thing that I think we need to do a little bit more
work on before the end of the day.  We have one -- and that's back to
the Gulf oil and Gulf oil-related issues.  We have a workgroup that we
chartered at our last meeting, and we heard a report about where the
agencies are with regard to the Gulf oil response.

		We need to decide what we as a committee do next with that workgroup.
And there are a couple of possibilities.  One is that we disband it.
Another is that we wait until we hear what the agencies learn about --
what they come up with regarding lessons learned.  And then we relook at
that workgroup and see whether or not there is another task for it.
Maybe there is another immediate task that we would assign to that
workgroup.

		One suggestion that Peg made yesterday that might make some sense and
I want to talk about would be as the next step providing some advice to
the agencies about some of the things that we want to be sure that they
would look at in this exercise of coming up with lessons learned so that
when they came back -- when there was a report about lessons learned, we
have some confidence that they were going to include some things we were
interested in.  Emory?

		MR. KNOWLES:  Just a suggestion, perhaps broaden the workgroup; rather
than just calling it, you know, the Gulf response workgroup, the
emergency response workgroup.  Again, I go back to a comment I made
yesterday.  You know, we had the World Trade Center disaster, which
presented a whole set of unique issues and problems that the agency had
to face, like all the responders did, immediately.  They had to make a
ton of decisions and implement innovative approaches to occupational
health and safety.  Now we have the Gulf disaster.  Again, they had to
regroup, rethink, do all that again.  Lord only knows what other
disasters we may face in the future, but sit down and think
strategically about how the agencies can proactively plan for the wide
array of potential disasters that they may face.

		MR. SILVERSTEIN:  Right.  I think that Denise did make the suggestion
yesterday that we broaden the charter of that group, and perhaps even
change its name to be something along the lines of protection of workers
in emergency response situations, or how do we ensure that worker
protection takes higher priority during emergencies.  I mean, we can do
that, but it would still leave us with the question of what do we next
with that group.

		MR. KNOWLES:  Yeah.  I don't want to show my ignorance, but after the
World Trade Center, was there a lessons learned set of meetings
following that within OSHA, within OSHA?

		MS. SEMINARIO:  Yeah.  And they issued a report.

		MR. KNOWLES:  I don't remember.

		MS. SEMINARIO:  And the one thing that they didn't even address -- it
was called, "Inside the Green Line."  And it was more of a report than
it was a lessons learned.  They didn't mention the health effects in the
report, and we now have 15,000 people sick.  So I would say that they
missed a big piece of the issue.  Part of it -- at that point when they
issued the report, they didn't know the effects.  But clearly what
happened after the World Trade Center had a huge impact on the agency
now because in the World Trade Center, they look at just the PELs.
Here, they knew -- you just looked at the exposure limits as being the
indicator of protective measures -- that they were going to end up in
trouble.  So they did learn, even though it wasn't in the formal report.

		MR. SILVERSTEIN:  A question for the group.  Shall we expand the
charter and rename that group?

		FEMALE VOICE:  Take a vote or --

		MR. SILVERSTEIN:  Yes or no.

		MS. MURRAY:  Can we expand it to what, to the second bucket or not?
Or just --

		MR. BUCHAN:  Are you talking about the small --

		MR. SILVERSTEIN:  Yeah.  I was just thinking about that, leaving that
group in place -- we have a charter for it -- but expanding it, maybe
renaming it, and maybe it becomes --

		MS. MURRAY:  I'm asking you what are trying to expand it to, a third
subgroup or morph it into one of these two.

		MR. SILVERSTEIN:  Would it work to morph it into one of the two that
we've been talking about or not?

		MS. MURRAY:  I don't know.

		MR. SILVERSTEIN:  Peg?

		MS. SEMINARIO:  My sense is right now, from everything that we've
heard, that it would be better to spend some time, I think today, just
to talk about what we would like the agency to -- some of the things we
want them to consider in their lessons learned, and that should be
included in part of that evaluation so that they don't miss -- for
example, talk about health effects.  They won't here.  But the things
that we think need to be included in that evaluation and lessons
learned.

		As I think Emory said before, somebody said, let's wait to see what
comes back from that, to see what they say, to see then what is needed.
Do we think we can provide some advice in terms of some implementation
on those lessons learned rather than just being in a vacuum, you know,
and disconnected from what the agencies are doing right now.  That would
be my thought, and just keep whether or not we want to have a workgroup
expanded on hold, not disband the current workgroup, but just keep that
issue on hold until we see what comes back from the agency.

		MR. SILVERSTEIN:  I like that idea.  I like that idea, which if I
understand correctly, it would mean leaving the group the way it is for
the time being, fashioning by the end of today a few questions we would
ask that the agencies incorporate in their lessons learned activity, and
request that by our next meeting that the agencies come back and tell us
about the lessons learned, and then we can come back to see whether or
not that workgroup should continue, what it should do next, whether it
should be expanded.

		Does that work for everybody?

		MR. GODDARD:  I would tend to agree with that.  You know, I'm sitting
here looking at a report that is coming through for clearance to the
agency that goes to the President and the oil spill recovery.  We right
in the midst of getting these investigative reports.  We're getting the
reports to the President.  There is a lot going on on the recovery
effort, and this has ecosystem impact in it, but it talks about the
federal agency responses, and this would be useful information that that
we would have soon that we could act on later if we had to.

		MR. SILVERSTEIN:  Okay.  Sarah?

		MS. SHORTALL:  Entertain a motion to the effect of (off-mic.).

		MR. SILVERSTEIN:  Sarah is suggesting a motion that would get us on
record with regard to what Peg was suggesting.  I'm not sure that we
need to do that because I think we're pretty close to being able to as a
group develop a request to the agency.

		MS. MURRAY:  It seems like we did that last time.  If we're just
leaving the group as it is.

		FEMALE VOICE:  Right, right.

		MS. MURRAY:  So Peg's suggestion is just don't change what the group
is doing, and we'll talk about it --

		MR. SILVERSTEIN:  Yeah.  We're not going to change the group, but
we're going to ask the agency to incorporate some -- to address some
issues in its deliberations about lessons learned, and to come back, and
to present the lessons learned to us.

		MS. SHORTALL:  My only thing for saying that is you asked does
everyone agree.  And we heard nothing from the group, and that doesn't
give us a chance for the transcript to accurately reflect --

		MR. SILVERSTEIN:  I understand, Sarah, but we'll get to that.  When we
have -- we're going to work on a set of questions to leave with the
agencies by this end of this meeting.  And before we actually leave it
with them, we'll either take a vote or we'll get some other sign of
agreement or disagreement.  So we'll take care of that.

		MS. SHORTALL:  All right.

		MR. SILVERSTEIN:  I appreciate the attention to it.  Peg?

		MS. SEMINARIO:  Unfortunately, I just have to step out just probably
for about 15 minutes, but I'll be right back.  I apologize.

		MR. SILVERSTEIN:  Okay.  So that's one task that we're going to need
to accomplish by the end of the day, and we may end assigning a couple
of people during lunch to come up with a draft of some questions that
we'll leave with OSHA and NIOSH.  And I think we'll wait until Peg comes
back to take that up again.

		Now, help me think through something here.  We've had two parallel
discussions, and I want to know whether or not it's possible to bring
them together or not.  The first was the discussion about two different
workgroups.  And then the second was the discussion about the ideas that
Dr. Michaels put before us, and we identified four different questions.
How do those things match up, or don't they?

		MR. BORWENGEN:  I think Peter had a suggestion, right?  What was your
comment?

		MR. DOOLEY:  Well, I think the comment was to incorporate the work on
the -- basically to be an advisory committee for the injury and illness
prevention, or to provide advice, and to have that be in one of the
buckets, bucket No. 2 or whatever.

		MR. SILVERSTEIN:  Well, what I heard Dr. Michaels saying is that any
advice that we provided that would help with what they're doing on
injury and illness prevention would be useful, but that that wasn't --
he was thinking at a broader level, in which the injury and illness
prevention role would simply be one piece of what we're advising.  I
didn't hear him saying we want you to give us advice about what should
be in the I2P2 rule.

		MR. KNOWLES:  Just a comment.  We have a dilemma with the I2P2 rule
anyhow.  It's already going through SBREFA rule.  So we're not going to
be able to change that.  If we change it, it's going to have to go back
through the whole review process again.

		MS. SHORTALL:  No, no.  That's not exactly accurate.  What goes before
the SBREFA -- and they're still months away from that.  What goes before
SBREFA is looking specifically at the issues as it pertains to small
businesses.  But as I said before, although they don't invite your
comment, you certainly are able to make comments.  And historically, the
agency has looked at all comments they've received during SBREFA.  And
it is anticipated that after SBREFA, the agency will make changes to
whatever they're doing, both in terms of whatever their PRFA, which is
the preliminary regulatory flexibility analysis, probably as well as the
rule or the proposed rule itself.

		Once you've gone through SBREFA once, you don't have to go back again
unless the power decided is so radically changed it isn't even
recognized as being the same thing.  It's just a one-time only.

		MR. KNOWLES:  Okay.  Thanks.

		MR. SILVERSTEIN:  Let me see if I could be a little bit more clear
about what I was saying.  I think that if we directed our attention to
advice about what we think should be in this I2P2, if we actually did
some work on a proposed design for the rule, it would be a more narrow
focus than what Dr. Michaels is asking us.  If, on the other hand, we
looked at the bigger issue of how these systems are designed and how
they are used, and had some advice about that, it would inform the
discussion about I2P2, and it would be useful in that whole process, but
it wouldn't be the sole focus for us.  Is that --

		MR. DOOLEY:  Yeah, I guess -- I mean, I'm not suggesting that it
should be limited to that.  But I am suggesting that Dr. Michaels was
saying that they have a specific proposal that they would be -- that
they were welcoming some, you know, advice and input on, and even
suggested the staff person to work with, and that data --

		MR. SILVERSTEIN:  No.  I actually heard him say they don't have the
specific proposal yet.  They are working towards one.  They would
provide us information that they are using in their discussion, but
they're not at the point of having a specific proposal.  Am I right?

		MR. GODDARD:  Yeah.  I think Mike's description of the -- Mike
Seymour's description of the -- is where they are, and it's not final.

		MR. SILVERSTEIN:  We can get a lot of information that will help us
understand how they're thinking, where they are in the process.  But