Farm Labor Perspectives on Working with Medical Providers


NORTHWEST JUSTICE PROJECT, Wenatchee



Introduction

  • Monolingual Spanish speaking farm workers are extremely vulnerable to pesticide exposure and are often afraid to speak out.
    • “The risk of developing prostate cancer was 14% greater for the pesticide applicators compared to the general population.” May 1, 2003, American Journal of Epidemiology.
  • Medical providers can aid farm workers by being on the look-out for pesticide exposures.
  • Farm workers may not inform the physician about pesticide exposure unless asked.
1. Ask the Right Questions

  • Where you suspect that the farm worker may have been exposed to pesticides ask questions about his or her work environment.
  • Keep track of the effects of exposure over time.
  • Under workers’ compensation, the Department of Labor and Industries will pay for the first visit to the doctor if the injury is work related. To approve the claim:
    • Must establish injury with “objective medical findings”
    • clear evidence of exposure
    • evidence of chemicals or pesticides
2. Worker’s Compensation Claims

  • Under the workers’ compensation system, the standard principles of toxicology are applied to all exposure claims, including pesticide claims.
  • The Department requires “objective medical findings” in pesticide exposure claims and accepts such claims, where the following exists:
    • clear documentation of exposure (blood tests, other confirming tests)
    • the doctor relates the worker’s complaints/condition to the pesticide exposure
  • The Department of Labor and Industries generally receives pesticide information under such claims, as growers are required to keep pesticide application records.
  • The Department can identify pesticide exposure claims by the use of key words such as “spray” or “pesticides” in the Report of Accident form.
  • Document the farm worker’s pesticide exposure, even where the symptoms of this particular exposure are not acute, as the worker may suffer from cumulative exposures.
3. Indicators of Possible Exposure

  • Where does the worker live?
  • Where does the worker work?
    • Farm workers that reside and/or work in or near orchards or fields are more likely to be exposed to pesticides, even without knowing it. (DOH, Summary Results of Yakima Farmworker Focus Groups About Pesticides and Health Care, 9/22/03 )
4. Where Symptoms Suggest Pesticide Exposure – Ask Direct Questions.
  • Were pesticides sprayed prior to field/orchard entry? – Any signs posted?
  • Were pesticides sprayed while working?
  • What crop was sprayed?
  • Drift exposure - Where did the exposure occur? Anyone spraying in the same orchard/field where live or work, or in an adjacent orchard/field?
  • Did other workers complain of similar symptoms? e.g., headaches, nausea, etc.
How was pesticide applied?

The method of application may aid in determining the pesticide.
  • Plane/helicopter?
  • Sprayer pulled by a Tractor?
  • Hand sprayers?
5. DETERMINING THE PESTICIDE

Pesticide Information Resources
  • Pesticide Known: The farm worker knows the pesticide name (and preferably has the label).
  • Pesticide Unknown: Where the farm worker does not know or is uncertain, there are a variety of resources available.
6. Right to Know
  • State Law Requires employers who apply or have others apply pesticides in connection with agricultural production must keep records for each application. RCW 49.70.119.
  • An employer must provide the pesticide record information to a health care professional where it is needed for treatment. RCW 49.70.119 (6).
  • The health care professional is NOT required to disclose the name of the employee. RCW 49.70.119 (6)(a).
  • An employer must provide the information immediately by telephone and within 24 hours provide a copy of the written record. RCW 49.70.119 (6)(b).
  • The employee is entitled to a copy of the pesticide information. RCW 49.70.119 (6)(c).
(a) If you know the brand name of the pesticide but don’t have the label go to
http://www.cdms.net/pfa/LUpdateMsg.asp



  • Services
  • LABEL & MSDS
  • US – Ag/Crop
  • US – T&O/Non-Crop
  • Canada – Ag/Crop
  • Canada – T&O/Non/Crop
(b) EPA diagnostic manual – Website at:
http://www.epa.gov/pesticides/safety/healthcare/handbook/handbook.htm



Includes:
The new revised version of EPA's pesticide poisoning handbook, 5th edition - Recognition and Management of Pesticide Poisonings edited by Dr. Routt Reigart and Dr. James Roberts, and published by EPA's Office of Pesticide Programs.

Both English and Spanish versions are available in PDF format.

(c.) Haz-Map Database Guide



Hazardous Agents
By Types of Agents
By Adverse Effects
Alphabetically
Occupational Diseases
By Types of Diseases
By Jobs and Symptoms
Alphabetically
High Risk Jobs
By Types of Jobs
Alphabetically

(d) Resources & Education for Achieving Community Health (REACH ) WSU’s hub website at:
http://www.wsulibs.wsu.edu/reach/

REACH



Includes:
National Network of Libraries of Medicine (NN/LM)
The mission of the National Network of Libraries of Medicine (NN/LM) is to advance the progress of medicine and improve the public health by:
1) providing all U.S. health professionals with equal access to biomedical information; and,
2) improving the public's access to information to enable them to make informed decisions about their health. The Program is coordinated by the National Library of Medicine and carried out through a nationwide network of health science libraries and information centers

(e) The National Environmental Education & Training Foundation

http://www.neetf.org/Health/providers/pesticides.shtm



Includes:

Pesticides Resource Library

With the prevalent use of pesticides in agricultural, urban, rural, workplace, and community settings, health care professionals are currently ill prepared to diagnose and treat pesticide-related health conditions. The information presented here has been gathered from various sources including the U.S. Environmental Protection Agency, National Pesticide Telecommunication Network, University Agromedicine Programs, American Academy of Family Physicians, Rachel Carson Council.and others. This information can be useful to health care providers in their education, research and practice to learn and understand more about pesticides issues.

(f) Pesticide Action Network of North America – PANNA website at www.pesticideinfo.org

 Includes:
  • Help Getting Started
  • Chemical Search or
    • Alphabetized
    • Chemical List
  • Product Search
  • New! Pesticide
    • Poisoning
    • Diagnostic Tool
(g) Californians for Pesticide Reform
www.pesticidereform.org/publications


  • Pesticides and Human Health: A Resource for Health Care Professionals
  • Pesticide Database
7. Are you getting Accurate Information?
  • Verify the type of pesticide utilized to the extent possible.
  • Investigate conflicting information.
Case example: Physician misdiagnosed a pesticide exposure as influenza where he was unaware that the orchard where farm worker was employed had recently been sprayed.

8. Identifying Patterns
  • Providers can play an important role in noting potential health effects. Watch for:
    • Clusters
    • Patterns of Acute Effects
    • Chronic events
  • Pass information about these patterns to DOH and academic researchers.
  • The cluster identification process is resulting in the Department of Labor and Industries' Chemically Related Illness unit generating more referrals to investigators to look into potential safety hazards.
  • A hospital ER worker observed numerous cases of both acute and chronic and pesticide exposure.
  • Watch for birth defects, cancers, neurological problems, reproductive problems, etc.
9. What Can You Do?
  • Confirm that laboratories are sending test results to the central database.
  • Tell farm workers and employers about the need for workplace investigations and removals when depression thresholds are exceeded, and of follow up to make sure those protections are happening. (Extremely Important!)
    • Pesticide-related illness is a reportable condition per WAC 246-101. You can report by calling the Washington Poison Center at 1- 800-222-1222.
  • Watch for depressions that are approaching thresholds and highlight these to workers and employers.
  • Watch for clusters of workers with depressions, even where those depressions don't exceed the threshold.
    • Several workers with 19% depressions at one orchard may signal the need for greater care
10. Share Your Concerns

  • As persons dedicated to protecting public health, providers are in a unique position, based upon firsthand observations, to educate others regarding the prevention of pesticide exposures to farm workers.
  • Share your concerns regarding the re-registration of pesticides that pose a significant health risk to farm workers.
  • Express concern about allowing the application of highly toxic and volatile pesticides next to fieldworkers/homes/schools, etc.
11. Keep Informed
  • Contact provider participants about avenues for providing general education.
  • Increase your knowledge and awareness about pesticide exposure.
    • "Associations between pesticide use and prostate cancer risk among the farm population have been seen in previous studies; farming is the most consistent occupational risk factor for prostate cancer," Michael Alavanja of the National Cancer Institute.
  • Collaborate and Communicate with Colleagues.
  • Know how to recognize and accurately diagnosis acute and chronic pesticide exposures.
Farm Labor Perspectives On Working With Medical Providers
February 19, 2004, Yakima, WA
Patrick Pleas, Staff Attorney, Farm Worker Unit,
NORTHWEST JUSTICE PROJECT, Wenatchee

Pesticide Information Resources (All referenced Sites are Free) (1) AG Chem Information Services If you know the brand name of the pesticide but don’t have the label go to: http://www.cdms.net/pfa/LUpdateMsg.asp. Includes: LABEL & MSDS information (2) Pesticide Action Network of North America – PANNA Website at www.pesticideinfo.org. Includes: Help Getting Started Chemical Search or Alphabetized Chemical List Product Search New! Pesticide Poisoning Diagnostic Tool (3) Resources & Education for Achieving Community Health (REACH - WSU’s hub website.) Includes: National Network of Libraries of Medicine (NN/LM) The mission of the National Network of Libraries of Medicine (NN/LM) is to advance the progress of medicine and improve the public health. (4) The National Environmental Education & Training Foundation Website at: http://www.neetf.org/Health/providers/pesticides.shtm Includes: Pesticides Resource Library With the prevalent use of pesticides in agricultural, urban, rural, workplace, and community settings, health care professionals are currently ill prepared to diagnose and treat pesticide-related health conditions. (5) Californians for Pesticide Reform Website at: www.pesticidereform.org/publications. Includes: Pesticides and Human Health: A Resource for Health Care (6) Information on Hazardous Chemicals and Occupational Diseases & Haz-Map Database Guide by Jay A. Brown, M.D., M.P.H. Website at: http://hazmap.nlm.nih.gov Includes: Health care providers trying to determine type of pesticide to search by Hazardous Agents, Occupational Diseases, and High Risk Jobs. (7) EPA diagnostic manual Website at: http://www.epa.gov/pesticides/safety/healthcare/handbook/handbook.htm Includes: The new revised version of EPA's pesticide poisoning handbook, 5th edition Recognition and Management of Pesticide Poisonings edited by Dr. Routt Reigart and Dr. James Roberts, and published by EPA's Office of Pesticide Programs. Both English and Spanish versions are available in PDF format. Pesticide Information: Washington, Department of Health Pesticide Program Office of Environmental Health & Safety 1-800-525-0127 Website: http://www.doh.wa.gov/CommunityandEnvironment/Contaminants/Pesticides.aspx

Washington Poison Center:
1-800-732-6985

Department of Agriculture
1111 Washington Street S.E.
P.O. Box 42560
Olympia, WA 98504-2560
(360) 902-1800; TTY (360) 902-1996
Pesticide Management Division
Call toll-free: 1-877-301-4555

Note: Pesticide-related illness is a reportable condition per WAC 246-101. You can report by calling the Washington Poison Center at 1-800-222-1222.


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