OSHA Part 2

Part 2 of this GHS discussion involves the current changes from Hazcom and how it affects the dental offices on a day by day basis.  First, we need to replace all of our MSDS forms with the new GHS SDS forms safety data sheets.  As I mentioned in Part 1, there are pictograms involved with the new SDS forms that have to be supplied to us by the manufacturers.  Interestingly enough, the compliance portion of the new regulations went into effect in 2014, and yet the Government in all of its wisdom mandated that the manufacturers do not have to supply us with the new SDS forms with appropriate pictograms until the end of 2015.  Therefore, in the meantime we continue to illegally use our old MSDS forms and have been in non-compliance until the final date given by the Government of June 1, 2016 for the manufacturers to comply.  I am sure you can imagine that due to cost considerations the manufacturers will not be supplying us with any SDS lists until the last minute which has been our experience thus far.  Hopefully, by the middle of next year we will have the new SDS pictograms and we can switch over to the SDS forms along with all the labeling that goes throughout the office where any of the hazardous chemicals are kept.  Now you are probably thinking that this is not a particularly big deal but to put it into perspective.  We have at this time over 300 MSDS forms in our binder that is a whole heck of a lot of labels that we have to print out and post in the proper area.  In the meantime, our current labels will remain and I suppose as long as you can speak and read English and live in the United States it is not a real big problem except the fact that you are at risk of not being informed and we are violating the OSHA regulations.  If all of this seems a little scary you do have to understand that our MSDS forms include things like our hand soap, Lysol spray, rubbing alcohol and a variety of other household chemicals that we use in the dental practice.  It is interesting to me that we have to label household materials in our office and you don't at home but that perhaps points out the relationship of Big Government and small business in America.  We are hoping for the best and maybe by the time you come in for your next appointment you will be able to see our nifty little pictograms on the walls.  See you at our next blog.

In Memorial

I wanted to take a moment to let all of my readers kn ow that my family suffered a huge loss a few weeks ago on my wife's and my 43rd anniversary.  Our lifelong companion and dear friend Pudge passed away while trying to get to the vet for emergency treatment.  Pudge was almost 13 years old and was diagnosed by her cardiologist with a cancerous tumor above her heart two weeks ago and given only a few months to live.  Unfortunately, her cancer was not treatable either by surgery, radiation or chemotherapy, thus we knew her time with us was limited.  Unfortunately, as many of you know, I have been blessed with a photographic memory which has served me well in Dentistry but it is torture for me now seeing Pudge laboring for breath as she passed away in Karen's arms over and over again.  Pudge was the alpha female of our family and ruled over our other four Corgi's even at the very end of her life.  You had to respect her tenacity, brashness and ability to bring a smile to the face of anyone she met.  Her demeanor was equally exquisite with infants, toddlers, small children as well as geriatric patients at care centers.  Karen and I often wondered how we were blessed with such a wonderful companion.  She was truly one of a kind and we miss her terribly.  She left her paw prints on our hearts.

OSHA Part 1

If it seems like I pick on the Government a lot in my blogs, you are probably right, but I feel that they pick on me even more.  One of our hygienists, who has been with us for over 20 years, has often made the observation that Government makes new rules just to see if I will continue to comply or just give it up.  I have always considered it a badge of honor to be in full compliance and so it will remain.  As for this blog it is about the new OSHA (Occupational Safety and Health Administration) regulation.  Most of you are aware of OSHA's primary obligation is to prevent evil bosses like myself from inflicting pain and suffering upon our employees.  In dentistry, OSHA covers both blood borne pathogens (infection) and hazardous communications of chemical hazards, Hazcom. There is a major change in OSHA at this time and Hazcom is the change. It is called GHS or Globally Harmonized System.  You will have to forgive me but whenever I see that term it reminds me of an old Coca Cola commercial, “I like to teach the world to sing in perfect harmony.”  This change from Hazcom to GHS has been occurring in stages over the last few years due to President Obama’s obsession with globalizing the economies.  His feeling is that since we live globally and our hazardous chemicals are sold abroad that we need to be able to communicate their dangers to people that don’t speak English and cannot read our MSDS (Material Safety Data Sheets) forms.  Therefore, he has adopted for us the 1998 United Nation's GHS rules regarding pictographs.  You know those little triangles with pictures of skulls and cross bones, flames or explosions printed inside of them.  These would be included with the English dialogue of hazards of spills, contaminations, etc (Gee, I wonder if the EPA has these kinds of labels on their spills in the Colorado rivers recently.)   Needless to say there is a huge amount of paperwork involved with all these changes.  Our old Hazcom, which used to be 28 pages long, now is over 100 pages long, and our very thick binder of MSDS forms will have to be replaced completely with the new SDS (Safety Data Sheets).   In any event, we'll discuss the importance of all this in my next blog, OSHA Part 2.

Your Donation Changes Lives!

Practicing dentistry for almost 40 years in Elk Grove with our large family of patients has put me in what I consider the unique position of observing a huge number of heartfelt personal stories.  Some of those stories I have already shared with you in previous blogs, but one very special story came up just the other day that I thought I should once again share with you.  One of our special needs patients came in with a wonderful story of his participation in the Special Olympics a few months ago in Los Angeles.  He had the singular honor of being picked to be a torch bearer for the opening of the games.  His only disappointment was that he could not actually participate in the games even though he had trained very hard in several events.  That is because as a torch bearer he could not compete as the organization tries to benefit as many people as possible.  Thus torch bearers cannot compete. Rest assured, he didn’t complain about it at all.  He was just thrilled to be a part of the whole gathering of wonderful people.  Now this patient has been with our practice for over 13 years and takes remarkably good care of himself with the help of his family and tremendous support of friends and the Special Olympics organization.  We have on many occasions had the opportunity to support his efforts both financially and with moral support and guidance.  But he is the one that deserves the special recognition for all of his tremendous efforts.  In speaking to him the other day, he would like nothing more than to have the support of our family of patients to help Special Olympics in any way that you can.  Please go to their web site and see what you can do to help this very worthy cause as it helps special needs patients like ours to be an active participant in our society.  After all this is what makes us who we are as a great country, a caring society, and very giving individuals.  Thank you in advance for all of your help and we look forward to many Special Olympics to come. Your Donation Changes Lives!

HIPAA Part 2

Time for our 2^nd chapter of the HIPAA saga.  As we left it last time, George Bush signed the High Tech Act into effect in 2002 and you would have thought that was the end of government intervention into our protected health information (PHI).  But that would be too easy.  The Office of Civil Rights (OCR) has continued to tinker with the privacy portion of HIPAA over the last 13 years, to the point that Congress felt obligated to pass the Omnibus Bill in 2013 which was signed into law by President Obama personal healthcare information.  So we are very restricted on who we can give out PHI to including even spouses, children and parents.  For example, we had a patient call up a few weekends ago with the need for antibiotic medication for a dental infection.  She was not feeling well enough to drive down to the office so we could dispense her the medication and she wanted to send her husband or her sister, who lives close by, to pick up the antibiotics and pain medication.  Unfortunately, since we did not have a signed HIPAA release for her to either her spouse or sister we could not dispense the medications for her.  In addition new FDA restrictions do not allow us to call in the medications to a pharmacy without a signed release form.  All the prescriptions now have to be handwritten out by the prescriber completely and picked up by the patient when the pharmacy does not have a signed release on file, HIPAA again.  Fortunately, she was eventually able to have someone drive her here to pick up her medications, but what a mess!  Does it really need to be this complex? Or is there some reasonable ground that we could offer privacy, but reasonableness.  By the way, the official list of definitions in the Omnibus bill is almost 20 pages long and we do now currently in our office have 14 different signature forms for your protected health information storage and dissemination requests.  As the definition of family, that government form is over 2 pages long.  If this seems like overkill, it probably is.  But leave it to the government to protect your personal identification just like they did for the over 20 million Federal employees that had their information hacked from Federal storage.  The take away message must be protect yourself as best you can and hope for the best.  After all, as my father told me, we live in a free country, not necessarily a fair one. 

HIPAA Part One

I have been spending many many odd time hours at the office recently.  It's not so that I can provide the best quality dental care to our large family of patients, but rather on reviewing new government regulations that affect my practice, as well as the practice of all of my peers and of medicine in general.  That acronym is HIPAA, which stands for the Health Insurance Portability and Accountability Act.  You will note that there is no word privacy here.  That is because that is not the reason for the law as it was written in 1996.  History shows us that the bipartisan law was proposed by Senator Ted Kennedy and Nancy Kassebaum and sent to President Bill Clinton for his signature in August 1996.  The reason for the law was a concern for what was termed “job lock” and the insurance coverage of pre-existing medical conditions.  In addition the government set about the process of trying to save money by verifying the portability of dental insurances.  There was also a mandate for fraud and abuse in the law and administrative simplification provisions which they thought could save the government somewhere between 3 or 4% in administrative costs for Medicaid and Medicare.  Yes, it is all about the money.  Then there was a provision in the law, put in the last minute, for privacy.   Kennedy and Kassebaum realized that there may be a problem with electronic transfer of data between insurance companies and the government and they assigned a mandate for congress to resolve this privacy issue within 3 years.  As you can expect, by 1999 they had not fulfilled that mandate, and the job was turned over to HHS (Health and Human Services) who established OCR (Office of Civil Rights) to write the privacy laws which came out in November 1999.  The document was 300 pages long and was released December of 2000.  In the “final regulations” they mentioned 265 times the term "reasonable" in trying to make the privacy laws appear to be easy to manage.  The final guidelines were released in July 2001.  But by then there were modifications of the Notice of Proposed Mandates that came out in March of 2002 which went into effect in October of 2002.  This eventually led to the forms that you sign at our office today, the “Notice of Privacy Provisions” and our “good faith effort” in getting you that information.  The unfortunate thing about this process is really the privacy portion of the law really boils down to a few short words “we get your PHI (personnel health information) from you and we should not give it to anyone without our permission.”   Unfortunately those few words translated into thousands of pages of documents from the federal government that we need to evaluate and respond to with hundreds of pages of documents of our own and many many hours of time.  All this is based on the goal of saving the government 3% on this cost.   How much does that cost us in the medical field that is passed onto you the consumer?  I am not sure,However I am sure it is much more than 3%.  I will review the next phase of HIPAA and its current status in my next blog beginning with the HITECH Act (Health Information Technology for Economic and Clinical Health) and the finally the Omnibus Bill passed in 2013.  

A History of Weather Patterns

I have been an observer of weather patterns for many years going back to my days at UC Irvine when friends of mine and I did a little weather study and challenged the local NBC affiliate and their anchor people Tom Brokaw, Bryant Gumbel and Kelly Lang their weather person to a little contest.  We ended up winning the contest, having rather simplistic weather models as our guide.  Since that time there is a general concept that the United States has had some really bizarre weather patterns.  Since 1992 (the start of our current global cooling pattern) we have experienced some of the most costly hurricanes and winter storms of the century, worse flooding in the history of the Mississippi and Missouri river valleys, one of our coldest winters and record breaking heat and droughts in the west.  The question is, what is making the weather change?  Is our weather becoming actually wilder?  The answer, according to those in the know, is that the weather is not becoming wilder.  The charts, grafts and histories show that the USA has long lived with floods, hurricanes, tornados, dust storms, blinding winter storms and droughts.  Nothing we have experienced so far signals that a long term change is underway.  Usually the worse weather is spread over decades.  Sometimes however the worse weather is drilled into a few years.  The 1930s was such a time, followed by a long calm.  Perhaps it is because we have gone out of a calm, the relatively quiet 70s and 80s, that weather we currently are having seems so foreboding.  Also during those calmer times we forget about the lessons of harsh weather.  In known hurricane alleys we replace old fashioned beach houses with million dollar homes and after a flood people often rebuild in flood planes with the hope that floods like those of the past won’t happen in the future (take North Natomas for example.)  When the inevitable storm comes and destroys again the monetary damages can seem astronomical.  Many of us in the west think of “wet” years as being normal and normal years being considered dry.  Past weather records and other kinds of less direct evidence show that what people may consider a drought has occurred many times in the past sometimes lasting scores of years that may be actually normal weather.  A hurricane that hits an area that has not been hit in 20 or 30 years or floods exceed those of the past few years or drops in an area that has unusually wet years for several years people start thinking the weather must be getting worse.  But is it the weather or our ignorance of it? As we enter into our next wet season the forecast seemed to call for El Nino and substantially heavy weather patterns.  Hopefully, we are not ignorant of the potential for flooding and that our government officials will be very cautious about where they allow new housing to be built.  In the meantime, at our office when we did our remodeling almost 10 years ago we updated the building to withstand 140 mph winds and 8.2 earthquakes.  In addition when the building was first built the floor is actually 9 inches higher than the highest flood waters ever recorded in the city of Elk Grove going back to the 1850s 100 years before Folsom lake was built.  So I think we will be able to weather whatever storms mother nature decides to bring our way.  Hopefully you will be able to stay high and dry also and will not suffer the follies of the past.