Kaiser Health News

Workers Pay the Price While Congress and Employers Debate Need for Heat Regulations

Published

9 months ago

September 5, 2023

https://kffhealthnews.org/ – Amy Maxmen – Tue, 05 Sep 2023 09:00:00 +0000

Sometimes the heat makes you vomit, said Carmen Garcia, a farmworker in the San Joaquin Valley of California. She and her husband spent July in the garlic fields, kneeling on the scorched earth as temperatures hovered above 105 degrees. Her husband had such severe fatigue and nausea that he stayed home from work for three days. He drank lime water instead of seeing a doctor because the couple doesn't have health insurance. “A lot of people have this happen,” Garcia said.

There are no federal standards to protect workers like the Garcias when days become excessively hot. And without bipartisan support from Congress, even with urgent attention from the Biden administration, relief may not come for years.

President Joe Biden in 2021 tasked the Occupational Safety and Health Administration with developing rules to prevent heat injury and illness. But that 46-step process can take more than a decade and might stall if a Republican is elected president in 2024, because the GOP has generally opposed occupational health regulations over the past 20 years. These rules might require employers to provide ample drinking water, breaks, and a cool-down space in shade or air conditioning when temperatures rise above a certain threshold.

On Sept. 7, OSHA will begin meetings with small-business owners to discuss its proposals, including actions that employers would take when temperatures rise to 90 degrees.

As this summer has broken heat records, Rep. Judy Chu (D-Calif.) and other members of Congress have pushed legislation that would speed OSHA's rule-making process. The bill is named after Asunción Valdivia, a farmworker who fell unconscious while picking grapes in California on a 105-degree day in 2004. His son picked him up from the fields, and Valdivia died of heatstroke on the drive home. “Whether on a farm, driving a truck, or working in a warehouse, workers like Asunción keep our country running while enduring some of the most difficult conditions,” Chu said in a July statement urging Congress to pass the bill.

Trade organizations representing business owners have fought the rules, calling the costs of regulations burdensome. They also say there's a lack of data to justify blanket rules, given variation among workers and workplaces, ranging from fast-food restaurants to farms. The U.S. Chamber of Commerce, one of the most powerful lobby groups in Washington, argued that such standards are nonsensical “because each employee experiences heat differently.” Further, the Chamber said, measures such as work-rest cycles “threaten to directly and substantially impair … employees' productivity and therefore their employer's economic viability.”

“Many heat-related issues are not the result of agricultural work or employer mismanagement, but instead result from the modern employee lifestyle,” the National Cotton Council wrote in its response to proposed regulations. For example, air conditioning makes it more difficult for people to adapt to a hot environment after being in a cold dwelling or vehicle, it said, noting “younger workers, who are more used to a more sedentary lifestyle, cannot last a day working outside.”

The Forest Resources Association, representing forest landowners, the timber industry, and mills, added that “heat-related illnesses and deaths are not among the most serious occupational hazards facing workers.” They cited numbers from OSHA: The agency documented 789 heat-related hospitalizations and 54 heat-related deaths through investigations and violations from 2018 to 2021.

OSHA concedes its data is problematic. It has said its numbers “on occupational heat-related illnesses, injuries, and fatalities are likely vast underestimates.” Injuries and illnesses aren't always recorded, deaths triggered by high temperatures aren't always attributed to heat, and heat-related damage can be cumulative, causing heart attacks, kidney failure, and other ailments after a person has left their place of employment.

The Toll of Temperature

To set regulations, OSHA must get a grasp on the toll of heat on indoor and outdoor workers. Justification is a required part of the process because standards will raise costs for employers who need to install air conditioning and ventilation systems indoors, and those whose productivity may drop if outdoor workers are permitted breaks or shorter days when temperatures climb.

Ideally, business owners would move to protect workers from heat regardless of the rules, said Georges Benjamin, executive director of the American Public Health Association. “We need to do a better job of convincing employers that there is a trade-off between efficiency and sick workers,” he said.

Garcia and her husband suffered the symptoms of heat exhaustion: vomiting, nausea, and fatigue. But their cases are among thousands that go uncounted when people don't go to the hospital or file complaints for fear of losing their jobs or immigration status. Farmworkers are notoriously underrepresented in official statistics on occupational injuries and illness, said David Michaels, an epidemiologist at George Washington University and former OSHA administrator. Researchers who surveyed farmworkers in North Carolina and Georgia found that more than a third of them had heat illness symptoms during the summers of their studies — far higher than what OSHA has registered. Notably, the Georgia study revealed that 34% of farmworkers had no access to regular breaks, and a quarter had no access to shade.

Even cases in which workers are hospitalized might not be attributed to heat if doctors don't make note of the connection. Many studies link occupational accidents to heat stress, which can cause fatigue, dehydration, and vertigo. In a study in Washington state, farmworkers were found to fall off ladders more often in June and July, among the hottest and most humid months. And in a 2021 report, researchers estimated that hotter temperatures caused approximately 20,000 occupational injuries a year in California between 2001 and 2018, based on workers' compensation claims.

Heat-related kidney injuries also come up in OSHA's database of workers severely injured on the job, like an employee at a meat processing plant hospitalized for dehydration and acute kidney injury on a hot June day in Arkansas. But research finds that kidney damage from heat can also be gradual. One study of construction workers laboring over a summer in Saudi Arabia found that 18% developed signs of kidney injury, putting them at risk of kidney failure later.

In addition to quantifying the injuries and deaths caused by heat, OSHA attempts to attach a cost to them so it can calculate potential savings from prevention. “You've got to measure things, like what is a life worth?” Michaels said. To workers and their families, suffering has far-reaching consequences that are hard to enumerate. Medical costs are more straightforward. For example, OSHA estimates the direct cost of heat prostration — overheating due to heatstroke or hyperthermia — at nearly $80,000 in direct and indirect costs per case. If this seems high, consider a construction worker in New York who lost consciousness on a hot day and fell from a platform, suffering a kidney laceration, facial fractures, and several broken ribs.

Putting a Price Tag on Heatstroke

Researchers have also tried to tease out the cost to employers in lost productivity. Work moves less efficiently as temperatures rise, and if workers are absent because of illness, and if they have to be replaced, production diminishes as new workers are trained to do the job. Cullen Page, a line cook in Austin, Texas, and a member of the union Restaurant Workers United, works for hours in front of a pizza oven, where, he said, temperatures hovered between 90 and 100 degrees as heat waves blanketed the city in August. “It's brutal. It affects your thinking. You're confused,” he said. “I got a heat rash that wouldn't go away.” Because it's so hot, he added, the restaurant has a high employee turnover rate. An adequate hood vent over the ovens and improved air conditioning would help, he said, but the owners have yet to make upgrades.

Via 313, the pizza chain where Page works, did not respond to requests for comment.

Page is not alone. An organization representing restaurant employees, Restaurant Opportunities Centers United, surveyed thousands of workers, many of whom reported “unsafely hot” conditions: 24% of those in Houston, for example, and 37% in Philadelphia.

“Workers have been exposed to working temperatures of up to 100 degrees after air conditioners and kitchen ventilators were broken, making it uncomfortable and hard for them to breathe,” wrote another group that includes members in the fast-food industry, the Service Employees International Union, in a comment to OSHA. “There is no reason to further delay the creation of a standard when we know the scale of the problem and we know how to protect workers.”

Researchers at the Atlantic Council estimate the U.S. will lose an average of $100 billion annually from heat-induced declines in labor productivity as the climate warms. “It costs employers a lot of money to not protect their workers,” said Juley Fulcher, the worker health and safety advocate at Public Citizen, an advocacy organization in Washington, D.C., that is lobbying for the Asunción Valdivia bill to allow OSHA to enact regulations next year.

For a template, Fulcher suggested looking to California, Maryland, Nevada, Oregon, and Washington, the only states with rules mandating that all outdoor workers have access to water, rest, and shade. Although the regulations aren't always enforced, they appear to have an impact. After California instituted its standard in 2005, fewer injuries were reported in workers' compensation claims when temperatures exceeded 85 degrees.

Michaels said OSHA has shown it can act faster than usual when Congress permits it. In the early days of the HIV/AIDS epidemic, the agency rapidly passed rules to prevent doctors, nurses, and dentists from being accidentally infected by needles. A similar urgency exists now, he said. “Given the climate crisis and the lengthening of periods of extreme heat,” he said, “it is imperative that Congress pass legislation that enables OSHA to quickly issue a lifesaving standard.”

The post Workers Pay the Price While Congress and Employers Debate Need for Heat Regulations appeared first on https://kffhealthnews.org/

Post Views: 314

Related Topics:Featured Health Kaiser Health News News

Up Next

Mississippi’s Cervical Cancer Deaths Indicate Broader Health Care Problems

Don't Miss

NPR and KFF Health News Share the Story of Two Health Heroes Who Helped Stop Smallpox

Kaiser Health News

The Lure of Specialty Medicine Pulls Nurse Practitioners From Primary Care

Published

3 days ago

May 17, 2024

Staff Editor

Michelle Andrews
Fri, 17 May 2024 09:00:00 +0000

For many patients, seeing a nurse practitioner has become a routine part of primary care, in which these “NPs” often perform the same tasks that patients have relied on doctors for.

But NPs in specialty care? That's not routine, at least not yet. Increasingly, though, nurse practitioners and physician assistants are joining cardiology, dermatology, and other specialty practices, broadening their skills and increasing their income.

This development worries some people who track the health workforce, because current trends suggest primary care, which has counted on nurse practitioners to backstop physician shortages, soon might not be able to rely on them to the same extent.

“They're succumbing to the same challenges that we have with physicians,” said Atul Grover, executive director of the Research and Action Institute at the Association of American Medical Colleges. The rates NPs can command in a specialty practice “are quite a bit higher” than practice salaries in primary care, he said.

When nurse practitioner programs began to proliferate in the 1970s, “at first it looked great, producing all these nurse practitioners that go to work with primary care physicians,” said Yalda Jabbarpour, director of the American Academy of Family Physicians' Robert Graham Center for Policy Studies. “But now only 30% are going into primary care.”

Jabbarpour was referring to the 2024 primary care scorecard by the Milbank Memorial Fund, which found that from 2016 to 2021 the proportion of nurse practitioners who worked in primary care practices hovered between 32% and 34%, even though their numbers grew rapidly. The proportion of physician assistants, also known as physician associates, in primary care ranged from 27% to 30%, the study found.

Both nurse practitioners and physician assistants are advanced practice clinicians who, in addition to graduate degrees, must complete distinct education, training, and certification steps. NPs can practice without a doctor's supervision in more than two dozen states, while PAs have similar independence in only a handful of states.

About 88% of nurse practitioners are certified in an area of primary care, according to the American Association of Nurse Practitioners. But it is difficult to track exactly how many work in primary care or in specialty practices. Unlike physicians, they're generally not required to be endorsed by a national standard-setting body to practice in specialties like oncology or cardiology, for example. The AANP declined to answer questions about its annual workforce survey or the extent to which primary care NPs are moving toward specialties.

Though data tracking the change is sparse, specialty practices are adding these advanced practice clinicians at almost the same rate as primary care practices, according to frequently cited research published in 2018.

The clearest evidence of the shift: From 2008 to 2016, there was a 22% increase in the number of specialty practices that employed nurse practitioners and physician assistants, according to that study. The increase in the number of primary care practices that employed these professionals was 24%.

Once more, the most recent projections by the Association of American Medical Colleges predict a dearth of at least 20,200 primary care physicians by 2036. There will also be a shortfall of non-primary care specialists, including a deficiency of at least 10,100 surgical physicians and up to 25,000 physicians in other specialties.

When it comes to the actual work performed, the lines between primary and specialty care are often blurred, said Candice Chen, associate professor of health policy and management at George Washington University.

“You might be a nurse practitioner working in a gastroenterology clinic or cardiology clinic, but the scope of what you do is starting to overlap with primary care,” she said.

Nurse practitioners' salaries vary widely by location, type of facility, and experience. Still, according to data from health care recruiter AMN Healthcare Physician Solutions, formerly known as Merritt Hawkins, the total annual average starting compensation, including signing bonus, for nurse practitioners and physician assistants in specialty practice was $172,544 in the year that ended March 31, slightly higher than the $166,544 for those in primary care.

According to forecasts from the federal Bureau of Labor Statistics, nurse practitioner jobs will increase faster than jobs in almost any other occupation in the decade leading up to 2032, growing by 123,600 jobs or 45%. (Wind turbine service technician is the only other occupation projected to grow as fast.) The growth rate for physician assistants is also much faster than average, at 27%. There are more than twice as many nurse practitioners as physician assistants, however: 323,900 versus 148,000, in 2022.

To Grover, of the AAMC, numbers like this signal that there will probably be enough NPs, PAs, and physicians to meet primary care needs. At the same time, “expect more NPs and PAs to also flow out into other specialties,” he said.

When Pamela Ograbisz started working as a registered nurse 27 years ago, she worked in a cardiothoracic intensive care unit. After she became a family nurse practitioner a few years later, she found a job with a similar specialty practice, which trained her to take on a bigger role, first running their outpatient clinic, then working on the floor, and later in the intensive care unit.

If nurse practitioners want to specialize, often “the doctors mentor them just like they would with a physician residency,” said Ograbisz, now vice president of clinical operations at temporary placement recruiter LocumTenens.com.

If physician assistants want to specialize, they also can do so through mentoring, or they can receive “certificates of added qualifications” in 10 specialties to demonstrate their expertise. Most employers don't “encourage or require” these certificates, however, said Jennifer Orozco, chief medical officer at the American Academy of Physician Associates.

There are a number of training programs for family nurse practitioners who want to develop skills in other areas.

Raina Hoebelheinrich, 40, a family nurse practitioner at a regional medical center in Yankton, South Dakota, recently enrolled in a three-semester post-master's endocrinology training program at Mount Marty University. She lives on a farm in nearby northeastern Nebraska with her husband and five sons.

Hoebelheinrich's new skills could be helpful in her current hospital job, in which she sees a lot of patients with acute diabetes, or in a clinic setting like the one in Sioux Falls, South Dakota, where she is doing her clinical endocrinology training.

Lack of access to endocrinology care in rural areas is a real problem, and many people may travel hundreds of miles to see a specialist.

“There aren't a lot of options,” she said.

——————————
By: Michelle Andrews
Title: The Lure of Specialty Medicine Pulls Nurse Practitioners From Primary Care
Sourced From: kffhealthnews.org/news/article/nurse-practitioners-trend-primary-care-specialties/
Published Date: Fri, 17 May 2024 09:00:00 +0000

Did you miss our previous article…
https://www.biloxinewsevents.com/clean-needles-save-lives-in-some-states-they-might-not-be-legal/

Post Views: 45

Kaiser Health News

Clean Needles Save Lives. In Some States, They Might Not Be Legal.

Published

3 days ago

May 17, 2024

Staff Editor

Ed Mahon, Spotlight PA and Sarah Boden, WESA
Fri, 17 May 2024 09:00:00 +0000

Kim Botteicher hardly thinks of herself as a criminal.

On the main floor of a former Catholic church in Bolivar, Pennsylvania, Botteicher runs a flower shop and cafe.

In the former church's basement, she also operates a nonprofit organization focused on helping people caught up in the drug epidemic get back on their feet.

The nonprofit, FAVOR ~ Western PA, sits in a rural pocket of the Allegheny Mountains east of Pittsburgh. Her organization's home county of Westmoreland has seen roughly 100 or more drug overdose deaths each year for the past several years, the majority involving fentanyl.

Thousands more residents in the region have been touched by the scourge of addiction, which is where Botteicher comes in.

She helps people find housing, jobs, and health care, and works with families by running support groups and explaining that substance use disorder is a disease, not a moral failing.

But she has also talked publicly about how she has made sterile syringes available to people who use drugs.

“When that person comes in the door,” she said, “if they are covered with abscesses because they have been using needles that are dirty, or they've been sharing needles — maybe they've got hep C — we see that as, ‘OK, this is our first step.'”

Studies have identified public health benefits associated with syringe exchange services. The Centers for Disease Control and Prevention says these programs reduce HIV and hepatitis C infections, and that new users of the programs are more likely to enter drug treatment and more likely to stop using drugs than nonparticipants.

This harm-reduction strategy is supported by leading health groups, such as the American Medical Association, the World Health Organization, and the International AIDS Society.

But providing clean syringes could put Botteicher in legal danger. Under Pennsylvania law, it's a misdemeanor to distribute drug paraphernalia. The state's definition includes hypodermic syringes, needles, and other objects used for injecting banned drugs. Pennsylvania is one of 12 states that do not implicitly or explicitly authorize syringe services programs through statute or regulation, according to a 2023 analysis. A few of those states, but not Pennsylvania, either don't have a state drug paraphernalia law or don't include syringes in it.

Those working on the front lines of the opioid epidemic, like Botteicher, say a reexamination of Pennsylvania's law is long overdue.

There's an urgency to the issue as well: Billions of dollars have begun flowing into Pennsylvania and other states from legal settlements with companies over their role in the opioid epidemic, and syringe services are among the eligible interventions that could be supported by that money.

The opioid settlements reached between drug companies and distributors and a coalition of state attorneys general included a list of recommendations for spending the money. Expanding syringe services is listed as one of the core strategies.

But in Pennsylvania, where 5,158 people died from a drug overdose in 2022, the state's drug paraphernalia law stands in the way.

Concerns over Botteicher's work with syringe services recently led Westmoreland County officials to cancel an allocation of $150,000 in opioid settlement funds they had previously approved for her organization. County Commissioner Douglas Chew defended the decision by saying the county “is very risk averse.”

Botteicher said her organization had planned to use the money to hire additional recovery specialists, not on syringes. Supporters of syringe services point to the cancellation of funding as evidence of the need to change state law, especially given the recommendations of settlement documents.

“It's just a huge inconsistency,” said Zoe Soslow, who leads overdose prevention work in Pennsylvania for the public health organization Vital Strategies. “It's causing a lot of confusion.”

Though sterile syringes can be purchased from pharmacies without a prescription, handing out free ones to make drug use safer is generally considered illegal — or at least in a legal gray area — in most of the state. In Pennsylvania's two largest cities, Philadelphia and Pittsburgh, officials have used local health powers to provide legal protection to people who operate syringe services programs.

Even so, in Philadelphia, Mayor Cherelle Parker, who took office in January, has made it clear she opposes using opioid settlement money, or any city funds, to pay for the distribution of clean needles, The Philadelphia Inquirer has reported. Parker's position signals a major shift in that city's approach to the opioid epidemic.

On the other side of the state, opioid settlement funds have had a big effect for Prevention Point Pittsburgh, a harm reduction organization. Allegheny County reported spending or committing $325,000 in settlement money as of the end of last year to support the organization's work with sterile syringes and other supplies for safer drug use.

“It was absolutely incredible to not have to fundraise every single dollar for the supplies that go out,” said Prevention Point's executive director, Aaron Arnold. “It takes a lot of energy. It pulls away from actual delivery of services when you're constantly having to find out, ‘Do we have enough money to even purchase the supplies that we want to distribute?'”

In parts of Pennsylvania that lack these legal protections, people sometimes operate underground syringe programs.

The Pennsylvania law banning drug paraphernalia was never intended to apply to syringe services, according to Scott Burris, director of the Center for Public Health Law Research at Temple University. But there have not been court cases in Pennsylvania to clarify the issue, and the failure of the legislature to act creates a chilling effect, he said.

Carla Sofronski, executive director of the Pennsylvania Harm Reduction Network, said she was not aware of anyone having faced criminal charges for operating syringe services in the state, but she noted the threat hangs over people who do and that they are taking a “great risk.”

In 2016, the CDC flagged three Pennsylvania counties — Cambria, Crawford, and Luzerne — among 220 counties nationwide in an assessment of communities potentially vulnerable to the rapid spread of HIV and to new or continuing high rates of hepatitis C infections among people who inject drugs.

Kate Favata, a resident of Luzerne County, said she started using heroin in her late teens and wouldn't be alive today if it weren't for the support and community she found at a syringe services program in Philadelphia.

“It kind of just made me feel like I was in a safe space. And I don't really know if there was like a come-to-God moment or come-to-Jesus moment,” she said. “I just wanted better.”

Favata is now in long-term recovery and works for a medication-assisted treatment program.

At clinics in Cambria and Somerset Counties, Highlands Health provides free or low-cost medical care. Despite the legal risk, the organization has operated a syringe program for several years, while also testing patients for infectious diseases, distributing overdose reversal medication, and offering recovery options.

Rosalie Danchanko, Highlands Health's executive director, said she hopes opioid settlement money can eventually support her organization.

“Why shouldn't that wealth be spread around for all organizations that are working with people affected by the opioid problem?” she asked.

In February, legislation to legalize syringe services in Pennsylvania was approved by a committee and has moved forward. The administration of Gov. Josh Shapiro, a Democrat, supports the legislation. But it faces an uncertain future in the full legislature, in which Democrats have a narrow majority in the House and Republicans control the Senate.

One of the bill's lead sponsors, state Rep. Jim Struzzi, hasn't always supported syringe services. But the Republican from western Pennsylvania said that since his brother died from a drug overdose in 2014, he has come to better understand the nature of addiction.

In the committee vote, nearly all of Struzzi's Republican colleagues opposed the bill. State Rep. Paul Schemel said authorizing the “very instrumentality of abuse” crossed a line for him and “would be enabling an evil.”

After the vote, Struzzi said he wanted to build more bipartisan support. He noted that some of his own skepticism about the programs eased only after he visited Prevention Point Pittsburgh and saw how workers do more than just hand out syringes. These types of programs connect people to resources — overdose reversal medication, wound care, substance use treatment — that can save lives and lead to recovery.

“A lot of these people are … desperate. They're alone. They're afraid. And these programs bring them into someone who cares,” Struzzi said. “And that, to me, is a step in the right direction.”

At her nonprofit in western Pennsylvania, Botteicher is hoping lawmakers take action.

“If it's something that's going to help someone, then why is it illegal?” she said. “It just doesn't make any sense to me.”

This story was co-reported by WESA Public Radio and Spotlight PA, an independent, nonpartisan, and nonprofit newsroom producing investigative and public-service journalism that holds power to account and drives positive change in Pennsylvania.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

——————————
By: Ed Mahon, Spotlight PA and Sarah Boden, WESA
Title: Clean Needles Save Lives. In Some States, They Might Not Be Legal.
Sourced From: kffhealthnews.org/news/article/clean-needles-syringe-services-programs-legal-gray-area-risk-pennsylvania/
Published Date: Fri, 17 May 2024 09:00:00 +0000

Post Views: 89

Kaiser Health News

Watch: John Oliver Dishes on KFF Health News’ Opioid Settlements Series

Published

3 days ago

May 17, 2024

Staff Editor

Fri, 17 May 2024 09:00:00 +0000

Opioid manufacturers, distributors, and retailers are paying tens of billions of dollars in restitution to settle lawsuits related to their role in the nation's overdose epidemic. A recent broadcast of “Last Week Tonight With John Oliver” examined how that money is being spent by state and local governments across the United States.

The segment featured reporting from the KFF Health News series “Payback: Tracking the Opioid Settlement Cash.” You can learn more about the issue and read our collection of articles by Aneri Pattani here.

——————————
Title: Watch: John Oliver Dishes on KFF Health News' Opioid Settlements Series
Sourced From: kffhealthnews.org/news/article/watch-john-oliver-kff-health-news-payback-opioid-settlements-series/
Published Date: Fri, 17 May 2024 09:00:00 +0000

Post Views: 21