hospitals and other workplaces may be employed by a number of different employers. These employers share responsibility for employee safety and health under OSHA.

For example, a hospital may operate a tuberculin skin testing program only for its employees, meaning that each contractor that supplies the hospital with workers may have to set up its own testing program. Alternatively, a hospital may agree—for a fee—to also test a contractor’s employees.

Some responsibilities for tuberculosis control are not readily shared. In particular, hospitals typically must provide isolation rooms and ventilation equipment that protect both their employees and the employees of independent contractors. They may, however, contract for maintenance of the equipment.

Employees and Nonemployees

Federal law obligates employers to provide employees with safe working conditions and to comply with specific OSHA standards. In most situations, employers’ obligations do not extend to volunteers. If volunteers receive some significant compensation in kind (e.g., room and board), OSHA claims that an employee-employer relationship exists. Medical or other residents and fellows who are compensated for their services qualify as employees for purposes of federal occupational safety and health regulations. Medical, nursing, and other students who are not compensated do not appear to be covered, although a health care facility may still choose to test them or require that they be tested by their schools.

The situation with respect to physicians can be complicated. Within a hospital, patients may be seen by physicians who are employed by the hospital, physicians who are employed by an affiliated medical school, physicians who are employed by a managed care plan or other corporation, physicians who have incorporated their own practices, and physicians who practice without having incorporated or created an equivalent legal entity. Physicians in all but the last category appear to be subject to OSHA’s requirements for employee protection.

Resources and Enforcement Actions

The fiscal year (FY) 2000 budget authority for OSHA provided for $381 million in funding and for 2,262 full-time-equivalent employees (DOL, 2000). About $82 million of this total was designated for grants to state plan programs, and $141 million was designated for agency enforcement activities. Another $54 million was designated for federal compliance assistance, which involves various kinds of voluntary employer and



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement