Make your voice heard and support a strengthened Worker Protection Standard (WPS). Add your name to the National Clinician Sign-On Letter.
US Environmental Protection Agency
Pesticides: Agricultural Worker Protection Standard Revisions
Docket ID: EPA-HQ-OPP-2011-0184
As clinicians, we care about the health and safety of our country’s 2 million farmworkers and their families who work tirelessly to put food on our tables. We commend the US Environmental Protection Agency (EPA) for proposing a stronger Worker Protection Standard (WPS) to safeguard farmworkers from harmful exposures to pesticides. We write to support many aspects of the proposed rule that foster worker health and safety. We also wish to underscore areas of the rule in need of strengthening in order to better protect farmworkers.
Pesticides are widely used to produce the world’s food supply, to protect structures, to prevent disease transmission, and to control vector-borne diseases. As a group, however, pesticides contain some of the most toxic chemical substances produced by modern chemistry. They are also unique among toxic environmental contaminants found in our environment; like no other chemicals except war gases, pesticides are purposefully released into our environment with the intention of doing harm to living beings. Farmworkers are the population most overexposed to pesticides, and for far too long farmworkers have been treated as second class, afforded fewer protections than other workers. At a minimum, we call for farmworkers to be given the same protections afforded to workers in most other industries.
While there are costs associated with the protection of this important and vulnerable workforce, there is also an extraordinary cost to workers, farmers and our society for occupational illness and injury in terms of medical care, lost wages, and potential workers’ compensation insurance premiums for an occupational injury or illness. At the price of more than $250 billion a year, occupational conditions are the second costliest medical condition behind cardiovascular disease and ahead of cancer (Leigh 2011). The cost of illness and injury as a result of work-related pesticide exposure is challenging to assess. This is largely due to the current weaknesses in our regulations, formal and informal exclusions from the workers’ compensation systems, challenges in clinically confirming the diagnosis of pesticide poisonings, lack of understanding regarding incident reporting as well as patchwork surveillance systems. Additionally, many workers do not report overexposures as they do not understand their rights and fear losing their jobs.
Preventing occupational injury and exposure is fundamental to worker protection. It is imperative that we take the strongest regulatory approach to preclude farmworker exposure to pesticides and adequately address cases of overexposure. To that end, we recommend the following:
1. Training Frequency – We support annual pesticide safety training for workers and pesticide handlers. An informed workforce is an important first step in worker protection. Annual training will reinforce important pesticide safety practices and information to help workers better protect themselves and their families from pesticide overexposure. Pedagogically, it is unreasonable to expect a workforce characterized by limited formal education and low levels of literacy to retain training content beyond one year. Moreover, workers in most other industries receive annual safety training and farmworkers deserve the same protection.
2. Training Content - We support expanding the content of the required training for workers and handlers, underscoring the importance of including the proposed topics of worker rights, emergency assistance and ways to minimize paraoccupational exposures or pesticide “take home” exposures. Additionally, we call for the EPA to emphasize training regarding the possible reproductive health effects of pesticide exposure.
3. Training Grace Period – We support the elimination of a grace period for worker training. Any training grace period severely undermines the intent of the Worker Protection Standard. An untrained worker is more vulnerable to pesticide overexposure and should not be permitted to work. In fact, it is the newest worker in all industries that is the most vulnerable to injury and death. Dr. David Michaels, Assistant Secretary of Labor for Occupational Safety and Health has said, “No worker's first day on the job should be their last day of their life.”
4. Minimum Age - We support the establishment of a minimum age of 18 rather than the proposed minimum age limit of 16 for pesticide handlers and early-entry workers. Children younger than 18 are still developing both physically and mentally, and high levels of exposure to pesticides could have life-long health effects. Furthermore, most minors do not have the maturity to follow all label instructions or take the necessary precautions to ensure the safety of other workers. Children working in other industries are prohibited from engaging in high hazard tasks, and the same should be true for children working around pesticides.
5. Hazard Communication – The EPA proposed rule takes a step in the wrong direction in its proposal to remove the requirement to post application-specific information in a central location. While EPA proposes that the information be made available upon request except in the case of a medical emergency, the proposed change places the onus of responsibility on the worker, advocate or clinician to obtain or request this information. Such information should be available in nonemergency situations and it should not require any type of request from the worker or worker representative. Even in nonemergency situations, healthcare providers need this information to assist in a differential diagnosis and for more accurate incident reporting. Workers may not understand that they have the right to request such information. And if they do, many will be reluctant (for fear of job loss) or unable due to language barriers, to ask their employer for the information.
6. Emergency Assistance – We support EPA proposal to require employers to make transportation to a medical facility available to workers and handlers within 30 minutes of learning of an exposure and to require the employer to provide to the worker, handler or the treating medical personnel the Safety Data Sheet and pesticide label, or all of the pertinent information in an alternate form (as opposed to waiting for it to be requested). In certain circumstances, employers should be required to document the time and length of the exposure and report it to the worker and clinician.
7. Other Information Needed by Healthcare Providers - By and large, healthcare providers have few clinical diagnostic tools readily available to help to better recognize and manage pesticide exposures. Additional information offered by a confirmatory diagnostic test is essential in providing information clinicians need to treat overexposed workers and handlers and to ultimately provide EPA with frontline data necessary to understand the health effects of registered pesticides. Providing clinicians with the clinical diagnostic tools they need to make the most accurate diagnosis possible should be a central part of worker protection, a feature that is glaringly absent in the proposed rule. Moreover, the proposed WPS underscores the importance of an informed clinician. We urge EPA to continue supporting healthcare provider training and technical assistance to improve the recognition and management of pesticide poisonings.
8. Monitoring Handler Exposure to Cholinesterase Inhibiting Pesticides – We support medical monitoring of pesticide handlers who mix, load or apply Toxicity Category I or II organophosphates or N-methyl carbamates. Monitoring programs have been successfully implemented for 40 years in California and over 10 years in Washington State, substantially helping to prevent overexposure of handlers. We strongly disagree with EPA’s decision not to implement such a program nation-wide based on its determination that these programs are “reactive, catching incidents after they occur rather than working to stop them from happening.” This analysis contradicts the very basic tenets of public health. These important medical monitoring programs are essential preventative measures, which successfully stop handlers from being overexposed. Medical monitoring is common in other industries and OSHA has promulgated over 25 specific standards for medical screening of workers exposed to hazardous substances (29 CFR 1910). Pesticide handlers deserve the same protections that are afforded to workers in other industries.
9. Respirator training and fitting - We support requiring employers of pesticide handlers to comply with OSHA-equivalent training on respirator use, fit-testing of respirators, and medical evaluation requirements whenever a respirator is required by the labeling. However, the rule should also include the OSHA requirement for each employer to adopt a worksite-specific respiratory protection program to address in detail how respirators are properly selected, cleaned, stored, repaired, and replaced. Furthermore, we disagree with EPA’s decision to exclude dust or mist filtering masks, since a majority of pesticides with label requirements for handlers to wear respirators only require dust/mist filtering respirators. Medical evaluation, fit-testing and training should be required for all types of dust/mist filtering respirators.
10. Decontamination supplies – We support the EPA recommendation to require employers to provide decontamination supplies that include one gallon of water per worker for routine washing and emergency eye flushing, soap, and single use towels and at least three gallons of water per worker for decontamination for workers performing tasks in a Restricted Entry area. We also recommend that the EPA require further decontamination supplies and require shower facilities onsite.
11. Contaminated Personal Protective Equipment (PPE) – We support the EPA proposal to require employers to render contaminated PPE unusable before properly disposing of PPE that cannot be decontaminated according to the manufacturer’s instructions. Such measures will prevent adverse health effects resulting from the wearing of contaminated garments.
12. Closed systems for mixing and loading – We support the EPA proposal to clarify the criteria for closed systems by adopting the California standards for system design. However, the EPA should go further and adopt, at a minimum, the California standards requiring the use of closed systems for highly-toxic categories of pesticides. Closed systems are already used extensively in California, and for some pesticides and certain types of uses across the country. The proper use of closed transfer systems for mixing and loading pesticides reduces the potential for human exposure from spills, splashes and blowing, and this type of engineering control– rather than PPE -- should be the first line of defense against pesticide exposure.
13. Drift protections – We support the EPA proposal to require handlers to cease application if someone other than a trained and properly equipped handler enters treated or surrounding areas. We also support the establishment of entry-restricted areas adjacent to the treated areas in farms and forests. Though modest in scope, the proposed entry-restricted areas are a step in the right direction to protect workers and others in the immediate vicinity of pesticide applications.
14. Early entry restrictions – We feel that early reentry for fieldwork should only be allowed in true agricultural emergencies. Worker protection during early reentry is largely dependent upon proper use of PPE. Many of the tasks involved with early reentry such as moving irrigation pipes and performing hand labor tasks may be cumbersome with required PPE. Given the nature of the tasks as well as the potential for escalating heat stress with PPE, there is potential for improper use or no use of PPE. The proposed improvements in training and age restriction cannot adequately mitigate these risks. In addition, we oppose the relaxing of the early reentry restriction for irrigators, allowing early reentry even if the need for irrigation could have been foreseen before the pesticide application. Irrigators are at high risk of pesticide poisoning because they tend to work long hours. They also often work alone with no coworker to assist in calling for help in case of pesticide or heat illness.
In conclusion, as clinicians concerned about the health and wellbeing of farmworkers, we strongly urge you to strengthen the current Worker Protection Standard.
Ed Zuroweste, MD
Chief Medical Officer
Migrant Clinicians Network
Michaels D. 2013. Temporary workers face unnecessary, life-threatening hazards. Accessed on 3/24/14 form https://www.osha.gov/temp_workers/OP_ED_Bay_Area.html
Leigh JP. 2011. Economic burden of occupational injury and illness in the United States, Milbank Q. 89(4):728-72.
Occupational Safety and Health Administration. General Industry. Medical screening and surveillance. 29 CFR 1910. Accessed on 3/24/2014 from https://www.osha.gov/SLTC/medicalsurveillance/