Opinion ID: 74019
Heading Depth: 3
Heading Rank: 4

Heading: Whether Supported by Substantial Evidence

Text: 52 Finally, we turn to the question whether OSHA's decision to allow non-physician licensed health care professionals to provide medical evaluation services to the same extent as physicians is supported by substantial evidence in the record as a whole. OSHA's statement in the notice of proposed rulemaking that it was considering diminishing the role of physicians in the medical evaluation process provoked a wide range of comment from multiple perspectives. As OSHA explains in the preamble to the Standard, some commenters recommended that non-physicians be permitted to administer questionnaires under the supervision of a physician. 63 Fed. Reg. at 1211. Some commenters recommended that only physicians be involved in medical evaluation programs. Id. Some commenters recommended that only health care professionals with certain degrees of specialization in occupational medicine be involved, without regard to whether they were physicians or not. Id. OSHA decided to allow non-physician licensed health care providers to perform medical evaluations to the extent allowed under state licensure laws. OSHA cited record evidence that non-physician health care professionals generally are qualified to assess an employee's ability to use a respirator based on uniform, accepted medical questionnaires, that they have in fact done so safely and effectively on many occasions, and that permitting their involvement would contribute to an efficient and effective allocation [of] health care resources. Id. at 1212. Moreover, OSHA concluded that non-physician health care professionals are capable of identifying cases that need to be referred to physicians, and would so refer cases when necessary or appropriate. OSHA noted the absence of any record support for continuingthe mandatory, exclusive role of physicians. Id. 53 We have reviewed the record and find OSHA's decision to be supported by substantial evidence. 11 While the comments were extremely varied, a common thread running through many of the comments was that registered nurses, physician's assistants, and other such health care providers are well-equipped to perform basic medical functions, such as assessing responses to medical questionnaires, provided that appropriate measures are in place for referring non-routine cases to a physician. There also was evidence from several commenters to the effect that they had safely and efficaciously used non-physician licensed health care professionals in the past for medical evaluations involving respirators. 63 Fed. Reg. at 1212. Moreover, the Non-Physician Involvement Provision does not automatically allow non-physician individuals to perform medical evaluation services; rather, it merely defers to state law on the extent of permissible involvement. State licensure laws can be trusted, as they are relied upon in similar contexts, to ensure that individuals performing medical evaluations under the Standard have the requisite competence, and such laws in fact typically provide for physician oversight over other health care professionals. See, e.g., Ala. Code 34-24-292; Fla. Stat. 458.347; O.C.G.A. 43-34-26.1. 54 The Doctors also make some arguments that are more closely akin to legal challenges than factual challenges. First, they claim that the Non-Physician Involvement Provision's deference to state law on who may perform medical evaluations abdicates OSHA's responsibility to promote the OSH Act's policy of uniform national standards. We reject this challenge. While the goal of the OSH Act is indeed to create uniform national standards for worker safety, the Doctors cite no case law saying that OSHA is statutorily bound to override state law on matters of general applicability, e.g., the licensure of health care professionals, to the extent that those matters happen to intersect with an occupational safety or health standard. Moreover, the Doctors have not demonstrated that the challenged deference to state law is likely to result in nonuniformity in the quality of the evaluation workers receive or in actual worker safety and health. Second, the Doctors suggest that the decisionto allow non-physician licensed health care professionals to perform medical evaluations may have been improperly motivated by economic considerations, i.e., that it would be too costly to require employers always to use physicians. We also reject this challenge. The record in this case makes it clear that economic considerations were not considered improperly. Rather, the record demonstrates that the decision to allow non-physician licensed health care professionals to perform the necessary evaluations was influenced by factual evidence to the effect that such persons are generally qualified to perform such services, and that state law provides an effective and sufficient way to gauge such qualification. OSHA did not conduct a cost-benefit analysis. Indeed, contrary to the Doctors' argument, the record suggests that economic considerations exercised little or no influence on OSHA's decision in this regard. Cf. 63 Fed.Reg. at 1173 (explaining that OSHA's final economic analysis did not attempt to factor in the offsetting value of cost savings from . . . allowing employers to use licensed health care providers in addition to physicians to perform medical evaluations). For all of these reasons, we uphold the Non-Physician Involvement Provision.