By: Mary M. Dockham

Ergonomics is the science of fitting the job to the worker. When there is a mismatch between the physical requirements of the job and the physical capacity of the worker, muscoskeletal disorders (MSD) can result. Workers who must repeat the same motion throughout their workday, who must do their work in an awkward position, who must use a great deal of force to perform their jobs, who must repeatedly lift heavy objects, or who face a combination of these risk factors are most likely to develop MSDs.

MSDs caused by ergonomic hazards are the biggest safety and health problem in the workplace today.

The U.S. Occupational Health and Safety Administration (OSHA) has issued its long awaited and controversial proposal for new ergonomic standards. OSHA is moving forward and has proposed an ergonomics standard to prevent work related musculoskeletal disorders, or MSDs.

OSHA has been working on an ergonomic standard for nearly a decade. It is certain that this proposed standard or some modified version will go into effect late this year or early 2001. Announcing the proposal on Nov. 23, 1999, U.S. Secretary of Labor Alexis Herman said, "Musculoskeletal disorders such as back injuries and carpal tunnel syndrome are the most prevalent, most expensive and most preventable workplace injuries in the country."

The statistics are staggering. MSDs are estimated to account for $1 of every $3 spent on workers' compensation costs. The U.S. Bureau of Labor Statistics reports that 62 percent of all illness cases reported in 1997 were MSDs and that 34 percent of all lost time accidents and illnesses were accountable to MSDs.

Estimates also indicate that 1.8 million workers suffer MSDs due to ergonomic causes. This accounts for more than $15 to $20 billion annually in direct costs such as medical expenses and indemnity. In addition, it accounts for up to $60 billion in total annual indirect costs such as absenteeism, retraining injured workers, training new employees to perform injured employee's jobs, decreased productivity, and poor employee morale.

Take, for example, the growing economic implications of carpal tunnel syndrome. In 1990, a carpal tunnel syndrome case cost an estimated $3,000 to $5,000. But in 1993, the cost estimate for carpal tunnel surgery and failure to return to work was $250,000. This workplace injury leads on an average to more days away from work that any other. Carpal tunnel cases involve more than 25 days away from work, compared to 17 for fractures and 20 for amputations.

On the surface, these numbers represent a problem of epidemic proportions. The reality is that MSDs have long been a workplace problem that has grown consistently throughout the years. The irony is that MSDs are preventable.

The New Standard

The new standard uses a job-based approach to define the scope and application of the standard. It will apply to three types of jobs in which MSDs are most severe.

Those include:

1. Manufacturing jobs. Those production jobs in which employees perform the physical work activities of producing a product.
2. Manual handling jobs. Those in which employees perform forceful lifting/lowering, pushing/pulling or carrying.
3. Jobs with a musculoskeletal disorder. All jobs in general industry where an employee reports a MSD that meet certain screening criteria.

Those engaged in construction, maritime activities or agriculture will have separate guidelines than these.

OSHA defines MSDs as injuries or disorders of muscles, tendons, joints, spinal discs, nerves, ligaments and cartilage. The standard identifies the following ergonomic risk factors: awkward or static postures, force, repetition, contact stress, vibration and exposure to cold. Under the proposed standard, all businesses with any workers who do manual lifting or repetitive motions would be required to identify and report ergonomic problems and to train employees on how to identify and avoid injury.

The standard also states that any business in which a worker reports an ergonomic injury would be required to identify and correct or eliminate the dangerous condition in that area of the workplace. This means that any business with even one worker reporting an ergonomic injury could be required to comply with the new law.

A full ergonomics program as defined by OSHA must contain these elements:

1. Management leadership and employee participation
2. Hazard information and reporting
3. Worksite analysis
4. Training
5. MSD management
6. Program evaluation

Under the new standard, employers with manufacturing and manual handling jobs would be required to implement the first two elements initially even if no MSD has occurred. Once a MSD is reported in manufacturing and manual handling jobs, employers must implement the remaining elements.

In general industry jobs, when a MSD is reported, employers must implement all six elements of the full ergonomics program. A quick fix option is available if the employer takes the steps to eliminate the hazard in 90 days according to specific criteria stated in the standard.

Problems for Employers

A controversial aspect of this standard involves modified work and compensation issues when a MSD injury occurs. According to the proposed standard, employees are entitled to "work restriction protection," or WRP, which requires an employer to maintain the earnings and other employment rights and benefits of employees who have been placed on restricted work status due to a MSD injury.

Vicki Sproat, an attorney who practices employment law with the Fort Myers law firm of Henderson, Franklin, Starnes & Holt, says that there is no question that the work restriction protection required by the new OSHA regulation will be costly for employers. Sproat warns, "The proposed OSHA regulation appears to be more demanding on employers than the Americans with Disabilities Act (ADA). Most courts and the EEOC have taken the position that the ADA does not require an employer to 'create' a light duty position for disabled workers. However, under the new regulation, OSHA not only requires employers to create light duty positions for workers with MSDs, but also mandates that employees on light duty be continued at full salary and benefits for up to six months. For employees who are temporarily and totally disabled from returning to the workplace due to a MSD, WRP requires the employer to pay the injured employee 90% of their after tax earnings and full benefits."

Sproat says it is difficult to determine how this would interact with the Florida's Workers' Compensation Law, The Americans with Disabilities Act (ADA), and the Family Medical Leave Act (FMLA). "OSHA apparently anticipates that the employer will pay the difference between what the employee is receiving in workers' compensation benefits and what OSHA mandates for work restriction protection," she observes. "Therefore, if an injured worker with a MSD is receiving 66 2/3 percent of their earnings as temporary total disability from workers' compensation, the employer may have to pay directly to the injured employee 23 1/3 percent of their earnings for up to six months if the injured worker is totally off work due to a work related MSD."

Sproat faults OSHA for failing to address how the new standard will affect an employer's obligation under FMLA. "Will an employee with a MSD who has been kept in a light duty job for six months and is unable to return to his or her regular job be eligible for FMLA leave for up to another 12 weeks?

"There are many unanswered questions, but one thing is clear," she says. "The new OSHA rule will be costly for employers and will increase the already overwhelming number of policies and procedures that modern day employers must implement, administer and coordinate."

Probable Costs

The new standard will cover over 27 million people and will, according to the Department of Labor, cost employers $4.2 billion. That breaks down to about $150 per employee. It is estimated that it will cost $150 per employee to set up an ergonomics program in the workplace. This does not include the costs should a MSD injury occur. If a reportable MSD injury occurs at the workplace, the costs to the employer significantly rise to include medical treatment, lost time and compensation.

Many small and medium sized businesses will find it very difficult to meet the costs associated with a MSD injury. The key to affordability is prevention. Business must do everything it can to see that MSD injuries are kept to a minimum in the workplace. "Unfortunately, the proposed regulation doesn't offer much guidance on how employers can prevent musculoskeletal disorders from occurring in the workplace," Sprout adds. "However, the preamble to the proposed regulation suggests that effective ergonomic programs are the most cost effective way to prevent or reduce work related MSDs."

A recent U.S. General Accounting Office study of several active company ergonomic programs found that these programs reduced MSDs and associated costs. The GAO also found that the programs and specific job modifications were not necessarily costly or complex for the employers. The fact that employers are achieving positive results with ergonomic programs is the best available evidence that ergonomic programs are feasible in controlling hazards and reducing MSDs in the workplace.

It would be prudent for business to implement programs necessary to adhere to the new standards. This will, in effect, help minimize the exposure and costs associated with MSD injuries in the workplace.

Remember, MSD injuries are preventable. Prevention is the key to cost containment. Business must be proactive on this issue rather than reactive. Reaction could be costly.

Mary M. Dockham RN, MBA is Managing Director at Workplace Advisory Services, Inc., a consulting company specializing in OSHA compliance, ergonomics, safety and safety training, Workers' Compensation case management, and health and wellness. For further information contact (941) 395-9297.