Occupational disease and injury reporting

All health care providers practicing in Massachusetts are required to report certain work-related diseases and injuries to DPH. These reporting requirements are part of a national effort to document the incidence of occupational diseases, injuries, and exposures, with the goal of preventing work-related health problems. The Code of Massachusetts Regulations (105 CMR 300) requires all health care providers to report the following diseases and injuries:

• Serious work-related traumatic injuries to persons under 18
• Work-related acute chemical poisoning
• Work-related lung disease
• Heavy metal absorption
• Outbreaks of work-related diseases

Any health care provider who diagnoses or identifies a reportable condition must report the case to DPH. Providers include:

• Physicians
• Nurses
• Psychologists
• Social workers
• Hospitals, clinics, or nursing homes

The health care provider may designate a staff person to complete the report.

Patient identifying information is confidential and will not be disclosed without patient permission, except as authorized by law, or when necessary to correct an imminent danger. Only aggregate data are available to the public.

HIPAA and reporting cases

Reporting cases to DPH does not violate HIPAA because Massachusetts’ regulations (105 CMR 300) require reporting of these occupational diseases and injuries. HIPAA expressly authorizes health care providers to disclose protected health information, without written permission of the individual, to DPH, the public health authority authorized to receive it (45 CFR § 164.512(b)).

Learn more information on HIPAA from the CDC.

The purpose of the reporting requirements is to identify workers at risk and potential workplace hazards that require preventive action. By reporting cases to DPH, health care providers play an important role in primary prevention of work-related health problems.

• You may be contacted to see if immediate action is needed. In some cases, DPH may request patient medical records or other information, as authorized by law (105 CMR 300.191).
• In some cases, the patient may be contacted for a telephone interview about the conditions at work that contributed to the disease or injury. Only patients who provide informed consent are interviewed.
• Worksite follow-up may be initiated after considering:
  • Seriousness of the hazard
  • Number of similar cases
  • Advice of the reporting health care provider
  • The wishes of the patient
• If appropriate, workplace evaluations will be conducted by a federal, state or local agency.
• You will be informed of referrals or other efforts made on behalf of your patients to reduce workplace hazards.
• Data are periodically summarized to identify industries and occupations in which workers are at risk.

• DPH’s periodic occupational health bulletins and data summaries describing occupational disease and injury in Massachusetts
• Educational materials for patients
• Technical consultations, if requested
• Presentation at grand rounds, conferences and association meetings
• Your patient’s workplace evaluation results, if a worksite visit is completed

Report all suspected or confirmed cases of:

Serious work-related traumatic injury to a person under 18

Any minor/young adult with a serious work-related traumatic injury, defined as an injury that results in death or hospitalization, or, in the judgment of the treating health care provider, results in:

• Significant scarring or disfigurement
• Permanent disability
• Protracted loss of consciousness
• Loss of body part or function
• Less significant injury but similar to injuries sustained by others at the same workplace

Sharps injuries as required by 105 CMR 130.1001 et seq.

OHSP also collects and analyzes information regarding percutaneous injuries among healthcare workers providing care in a hospital or satellite unit covered by the hospital's license. The instructions and the Annual Summary for Sharps Injuries are listed below for your convenience:

• Instructions for MDPH Annual Summary of Sharps Injuries  (DOC)
• Form for Annual Summary of Sharps Injuries, 2010 forward
• Instructions for MDPH Bloodborne Pathogen Exposure Incident Recording  (DOC)
• Form for MDPH Bloodborne Pathogen Exposure Incident Recording  (DOC)

Work-related acute chemical poisoning

Carbon Monoxide (CO) Poisoning

• Any patient with a physician’s diagnosis of CO poisoning AND a history of occupational exposure.

Pesticide Poisoning

• Any patient with a physician’s diagnosis of acute systemic illness or subacute illness or condition (e.g. dermatologic, ophthalmologic) due to pesticides; AND a history of occupational exposure.

Other Acute Chemical Poisoning

• Any patient with acute poisoning caused by occupational exposure to any other chemical (e.g. cyanide, hydrogen sulfide, chlorinated hydrocarbon solvents).

Work-related asthma

Patients with a physician’s diagnosis of asthma AND an association between symptoms and work:

• Newly sensitized by exposures at work, OR
• With pre-existing asthma exacerbated by exposures at work, OR
• For whom a one-time exposure to chemical(s) at work resulted in generalized airway hyperactivity.

Other work-related lung diseases

Chemical or Hypersensitivity Pneumonitis

• Diagnosis of pneumonitis; with a history of recent work exposure to a suspect agent

Pneumoconiosis

• Diagnosis of silicosis, asbestosis, berylliosis or other pneumoconiosis

Other possible work-related lung diseases

• COPD, infectious disease, bronchiolitis obliterans with suspicion of work causation or exacerbation

Heavy metal absorption

• Mercury (blood >15 μg/L, or urine >35 μg/gram creatinine)
• Cadmium (blood >5 μg/L, or urine >5 μg/gram creatinine)
• Any other case of heavy metal absorption believed to be related to exposures at work

Providers are not required to report elevated lead levels. Lead levels >0 μg/dL in blood in persons 15 years and older are reported by laboratories to the Massachusetts Occupational Lead Poisoning Registry.

Outbreaks of work-related diseases

Occurrence in a workplace of cases of an illness in excess of the number of cases usually expected. Work-related disease is defined as a disease or condition which is believed to be caused or aggravated by conditions in the individual’s workplace. Outbreaks or clusters are identified by significant increases in the usual frequency of the disease, among the specified population, at the same season of the year.