OCCUPATIONAL MEDICINE. Occupational hazards may exist in any industry, but a few Texas industries have been the object of special scrutiny. In the early twentieth century oil drilling was particularly dangerous. A physician practicing in 1918 near the Goose Creek oilfield recalled the "almost constant stream of oil field accidents" that kept him and the town's other doctors working night and day. Later the petroleum refineries and chemical industries became the subject of several widely read and controversial studies regarding the carcinogenicity of some petroleum derivatives. In response to these and similar concerns in manufacturing and agriculture, the state legislature adopted the Occupational Disease Reporting Act and the Hazard Communication Act in 1985. The former requires physicians and others to report such occupational diseases as asbestosis, silicosis, acute pesticide poisoning, and elevated levels of lead in the blood. The other law requires employers to provide information to employees about potentially hazardous chemicals in their work environments. The risks historically associated with mining and construction work prompted the state's first occupational safety laws in 1907 and 1919 respectively. In 1982 mining, construction work, and agriculture had the state's highest rates of work-related deaths, and in 1987 the construction industry in Texas had the nation's highest work-related fatality rate.
"Railroad medicine" was the first organized response to accidents or illness of a particular labor force. Railroad companies hired physicians in towns along the lines to care for employees who were sick or injured. In Galveston during the 1890s, for example, employees of the Atchison, Topeka and Santa Fe Railway had access to private surgeons, St. Mary's Infirmary (now St. Mary's Hospitalqv), and John Sealy Hospital for emergency treatment. Many prominent early-twentieth-century physicians served as railroad physicians, including Arthur Carroll Scott, Raleigh R. White, G. W. N. Eggers, and Albert O. Singleton. Railroad companies also established hospitals for nonemergency care. The Missouri Pacific opened its hospital in Marshall in 1876, and the Galveston, Harrisburg and San Antonio opened one in Columbus (1880). The Santa Fe Hospital in Temple was established in 1892. By 1936 there were eighteen railroad hospitals in the state. Other early industrial hospitals included the El Paso Smelter Hospital (1898) and the Texas Gulf Sulphur Company Hospital in Newgulf (1930).
After World War II most major industries increased their attention to issues of employee health and safety, stimulated partly by medical professionals and partly by new laws such as the federal Occupational Health and Safety Act of 1970. In October 1948 the first Gulf Coast Regional Conference on Industrial Health was held at Baylor Medical College in Houston. The conference was sponsored by the Public Health Committee of the Houston Chamber of Commerce, Baylor University College of Medicine, the Texas Department of Health, the Industrial Health Council of the American Medical Association, the Gulf Coast chapter of the American Society of Safety Engineers, the Houston branch of the American Association of Industrial Nurses, and the Industrial Hygiene Foundation of America. Some 200 persons, including plant managers and safety engineers, attended this conference. Follow-up conferences were held annually for several years.
Petrochemical corporations, among other large companies, have medical directors who oversee a wide range of health-related activities. Some companies have departments that investigate relationships between employment and disease or study the toxic properties of petroleum derivatives. Industrial hygienists monitor exposure of employees to toxic chemicals and other hazards and recommend actions to reduce danger. Safety engineers supervise fire and rescue squads. Many large plants have emergency medical technicians who work closely with the medical departments. The occupational medicine department of a large oil company may include as many as twenty-five medical professionals and scientists. In addition to medical research and industrial-safety programs, some companies provide primary medical care to employees. Tenneco, Incorporated, for example, established a primary health-care clinic in 1980. The company hoped to decrease absenteeism among its Houston-based employees because of illness and visits to physicians. The clinic is staffed by physicians, nurse practitioners, and registered nurses. During a one-year period (July 1, 1985, to June 30, 1986), 58 percent of the company's 3,644 employees used the clinic's health services for a total of over 10,000 primary-care visits. The services included such preventive measures as immunizations and pap smears, as well as diagnostic and treatment services for a variety of acute and chronic diseases. Tenneco has also been a national leader in the development of "wellness programs" for employees. The Tenneco Health and Fitness Program, begun in 1982, provides supervised aerobic, weight-training, and calisthenic classes for all Houston-based company employees.
Although oil and chemical companies in Texas have the largest and most advanced occupational medicine programs, there are also independent clinics that operate on a fee-for-service basis. Such industrial clinics as the Kelsey Seybold Clinic and the Milby Clinic in Houston and Hansen's Clinic in San Antonio provide health-care screening and episodic care for employees of smaller industries. Some of the work in industrial clinics and in the occupational-medicine departments of larger companies consists of services mandated by the United States Occupational Health and Safety Administration-for instance, physical exams to determine the amount of exposure to toxic substances like lead or vinyl chloride. Health care for agricultural workers is poorly organized by comparison. An exception is the clinics of the Hidalgo County Health Care Corporation, which provide comprehensive services for migrant farm workers. These clinics, sustained with funds appropriated by the federal Migrant Health Act of 1962, are especially concerned with screening workers for excessive pesticide exposure. Supplementary state funds were added in the late 1980s.
The practice of occupational medicine includes a range of health-care professionals: physicians, nurse practitioners, nurses, industrial hygienists, physician's assistants, toxicologists, and employee-assistance workers. Physicians wishing to specialize in occupational medicine are trained in residency programs after receiving the M.D. degree. The University of Texas Health Science Center at Houston has the only occupational medicine residency program in the state. The program began in 1977 and usually graduates two occupational-medicine physicians each year. Requirements include a year of clinical training, a year of academic studies in related fields such as epidemiology, and a year of supervised clinical work in either a corporation medical department or in a smaller industrial clinic. Tenneco, Shell Oil, Exxon Company, USAqv, Exxon Chemical Company, the Texas divisions of Dow Chemical and Union Carbide, as well as the smaller industrial clinics, provide opportunities for this clinical training. The Lyndon B. Johnson Space Center also provides an occupational-health preceptorship as part of the residency program. Special training in occupational medicine is also given to nurses and nurse practitioners. Texas Woman's University began the state's first program in occupational health nursing in the late 1970s. The University of Texas School of Public Health offers master's degree programs for nurses and nurse practitioners, industrial hygienists, and employee-assistance workers. Texas A&M University offers a master's degree in industrial hygiene, and the University of Houston at Clear Lake City offers a B.A. degree in industrial hygiene.
The professional organization for occupational medicine physicians is the Texas Occupational Medicine Association. TOMA was organized in 1955 and is the state affiliate of the American Occupational Medical Association, begun in 1916. In 1987 TOMA had 200 members from sixty-one cities throughout the state. Approximately half of the TOMA members practice in Houston, Dallas, and San Antonio.
Several state or federal statutes promote the health and safety of working men and women or provide compensation to workers for job-related injuries or illness. State legislators adopted the Workman's Compensation Act in 1913. Several amendments have been added since then; the entire law was retitled Workers' Compensation Act in 1977. This act allows employers to purchase liability insurance for compensating employees who experience work-related disabilities. Before 1947 the act applied only to accidental injuries and did not cover injury resulting from occupational disease. In 1947 the law was amended to make certain occupational diseases compensable. Not until 1971, however, was the act further amended to cover all occupational diseases and to remove the restrictions on compensation that were part of the 1947 law. The 1971 amendments also allowed recovery for work-related injuries that developed over a period of time, thus striking the previous condition that compensation was available only for injury from a particular, identifiable accident. The Industrial Accident Board, a state agency, administers the Workers' Compensation Act. In 1967 a new law authorized the establishment of the Occupational Safety Board, the Division of Occupational Safety with the state health department, and the position of state safety engineer. After the passage of the federal Occupational Safety and Health Act in 1970, the state adopted OSHA safety standards, thereby obviating the role of the state Occupational Safety Board. In 1985 this board was abolished and its duties transferred to the Division of Occupational Safety.
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