EDITORIAL HEALTH SERVICES FOR FEDERAL EMPLOYEES

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP59-00882R000200070013-6
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 14
• Document Creation Date: December 9, 2016
• Document Release Date: September 4, 2000
• Sequence Number: 13
• Publication Date: November 15, 1946
• Content Type: REPORT

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Tublic Health Reports
Vol. '01 ? NO\ E'NI BI-At 1.3, 1916 ? 1\'o. 46
Printed R'iih the Approval of the Bureau of the Budget as Required by Rule
42 of the Joint Committee on Printing
EDITORIAL
HEALTH SERVICES FOR FEDERAL EMPLOYEES'
Passant' of hlllllii L:1\t },~ t h,' ~ '~ Tilt\'-h1n1 ii Colign.'s wakes
posahlt' tllc rstahh.~11Inrnt ,f it f,r'rl',?Iltly, Illt'tlif ill (lriigrain fl or 1'tr14'rul
elliploVices. II 'atl of ,Irpurtnu lets 11nd Ii i I1(1es t,f till' FeIleral 6overn-
lilt'Ilt ttl(?Ilulill_ (lt,V t'rl,Illrl,t-t,Vl oltil mind -(-(lilt i'lillt'd eurporatioll,, after
con,111tiu~; \%ith tilt' l nit,-tl `iatr'= Pal lie Ilrultii SerMcm and after
ctlll,ldt?ratlorl of its r," oimiiiit'llliatloll.'. bill' t'-till,il,h cillpl(n'e(' 11 -.111th
program: for thr }tlrrl,t,", of promoting un.I tuaintailling the 11h-sisal
and int'imtal llraltll if tilt, t n11)1t,~'rc~ of illy Ft'dt r:ll {;o\t rnnu'ut.
Tier 1 imitl I ~t+1tt : Puhlie Ii,?altli er?t ic,? f?r plant- ve:irs ha, made
studies of -prrifie int:u,trial ali(1 I etipittioul,l haznr,ls arni has furl died
prof es`loriai a,lclct' 111)('11 r,'(t?It'-t t? prl\uto industry and to ligo ides
of tilt' Fell''ral C;,,Vrrllnlriit. M?tl\ intlli,triul A,r~auizattons au(Lroin-
nu regal e-tnhli,hrnent, h:1\, fL,ilndIhutrrllploVer h''altlt pr(,g1?anls!have
paid (li~itl,'ll,l~ in ir.(n a-eil t'flicisnt?}- w id productivity. it is n itici-
pated that it pre (?l.ti\?(' lnrdical progran1 oprrute(i bk- the. ,e\'(?ral
Federal d,'p:lrtu:' ;,t and .It e ieii' sht?ultl l,ru\?t' of gtealt valtle in
helping elnllloyt'e, to pt'rforin their nt sWfielI duties efficiently and
econortlirally.
"A Suggested flan for a Prrventice Medical Poigrarl in a Federal
Employet-' Ilcalth Sm'rvie,?" has ho-en f?rmuhtted and is pris,?nit'd in
detail in the following p:ig,?s of Puhlie 1tInlth Reports.; This plait is
subject to ntodifiellti(]n from tirn,- to tinu' in arrordallcr Hith the
evolution of preventive nielieinr.
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 \ovemb?r 15. 1946 1(42
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A SUGGESTED PLAN FOR A PREVENTIVE `i E D I C A L
PROGRAM IN A FEDERAL EMPLOYEES'
HEALTH SERVICE I
The essential elements hdicved to be desirable fo' 11 pet ventive
medical program ill it Federal employ-, cs' health service at this time
are set forth.
It is hoped that the plan sugestetl Will lie of assistance in developing,
establishing and operating employees' health services such as are
consistent %% ith the provisions of Public La%', 65S.
A Federal employees' health sei ice prograni hits two major
objectives:
A. To serve the employee- the Fetlt?ral employee (a taxpayer)-
b.- assisting him to maintain optimal health While on the joh.
B. To serve the employer the Gwvveriunent (all taxpavcin) by
increasing, or maintaining, production through the establishment and
maintcnaiu e of methods and stantlard- %% hick make it possible for the
employee to maintain optimal health in his total wort environment.
The major objectives should he consistent with: (I ) the funetion of
the agency or department ; +2) the Federal Government's responsi-
bility as fixed by Public Law 65S, Seventy-nuith Congres- hereafter
referrer' to as the Act; (3) the Federal Goveritnient's responsibility as
fix.'d by the Employees' Compensation Act of 1916 as tunefuied;
(4) the employee's relationship to his family physician and dentist;
(5) the codes of ethics of the medical, dental and nursing professions.
[Pinuc L. -.w 658- *79TI1 COKGRESSj
CHAPTER 865-2D SESSION]
[H. It. 27161
AN ACT
To provide for health program for Government employees
Be it enackd by the Senate and Ikntse of Repreaenlatire-s of the
United States of Antfrica in Congress usstmbled, That, for the purpose
of promoting and maintaining the physical and mental fitness of
employees of the Federal Government. the heads of departments
and agencies, including Government-owned and -controlled corpora-
$ From the Once of Fmiloyee-' nealtb, Bureau of Mid:cal Servten?s, United States Public Health
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1643
tions, are authorized, within the limits of appropriations made
available therefor, to establish, by contract or otherwise, health
service programs which will provide health services for employees
under their respective jurisdictions: Provided, That such health
service programs shall be established only after consultation with
the Public Health Service and consideration of its recommendations,
and only in localities where there are at sufficient number of Federal
employees to warrant the provision of such services, and shall be
limited to (1) treatments of on-the-job illness and dental conditions
requiring emergency attention; (2) preemployment and other examina-
tions: (3) referral of employees to private physicians and dentists;
and (4) preventive programs relating to health: Provided further,
That the health program now being conducted by the Tennessee
Valley Authority ani by the Panama Canal and Panama Railroad
Company shall not be affected by the provisions of this Act: And
provided further, That such health programs as are now being conducted
for other Federal employees may be continued until June 30, 1947.
The Public Health Service, when requested to do so, shill review the
health service programs beiik~ conducted by any department or
agency under authority of this Act and shall submit appropriate
comment and recommendations. Wherever the professional services
of physicians are authorized to be utilized under this Act, the defini-
tion of "physician" contained in the Act of September 7, 1916, as
amended (! . S. C., 1940 edition, title 5, sec. 790), shall be applicable.
Approved, August 8, 1946.
A. In accordance with the authority contained in the Act of August
8, 1946, the heads of departments and agencies, including Government-
owned and -controlled corporations, within the limits of appropriations
made available therefor, iiiay establish by contract or otherwise
health services for einploy(tes under their respective jurisdictions
according to any one, or combination, of the following:
1. Establish and operate their own health service pre ;rains;'
2. Contract for the establishment and operation of their health
service programs utiliziig:
a) other competent Federal agencies or department.;
b) private or public organizations capable of rendering the services required;
3. Establish and operate in part their own health service pro [grams
and contract in part for the services authorized.
B. The scope of the health servico programs as established in
Public Law 658 is:
1. "Treatment of on-the-joh illness and dcntai conditions requiring emetgvnc)-
attention ;
2. "Preemplovnn nt and other examinations;
3. "Referal of uuniploveea to private physicians and dentists;
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November 15, 1946 1644
IV. PROPOSED STANDARDS AND RE4.0NIMENDATIO!",",
The Public Ifealth firrvit?e reeonlnlends that:
A. Type of program, personnel need-, fttnt?tional organization -
1. All enlploVecs' Health service pro:rnnls he preventive ltenlth
progi ants.
2. The profes,tonal re;porisibility for the health service pro,rrams
be vested in the physit'ian iit t'hargc of the agency'; erllplt+ce' health
service.
3. Tile ph1-icitni ill char,- of the employ'ees' health service program
of a department or ageticy, including Government-owitt d and -con-
trolled corporations, be directly r('spon'ihle at tile level of the
principal administrative officer of the department or agent v-, including
Government-owia d and -controlled corporations.
The position taken by the Public Iiealtll Service at this time in
regard to the placement of it Federal en;plod ces' health service in the
functional organization of an agency or department is as folio's:
(a) The department or agency head, hccaiise -if the responsibility inherent in
his position, has the right to place the health cr% ice at tLe level he deem' proper
in his own department or arena:.
(b) The Public Stealth Service. &,~ the res'ilt of its experience with industry,
advises that the placement of III? health s rvice be at It hitvr; rrronin.ending
a;.t?n.I,rct'r tilt :+-',r. n.n,t..r tiir,?rn.ii,ing times for continuing the
1 1; .`tt:tiriiiiv fr,.in apps i m tt? witirt?t?tt irifiurniatit>n t'oncrrn-
lng ~ptrilii 1 al'I, Ii:uartl- 8htirlt to In- enrouLtc rid iii sit-r% irc outside
ti t ct,it,tiv :uul rtroruu,endirg pl(vautions t?t he taf-??n.
It) 'l'ilt I rernit.l .:rw?t health e\an.it ali.?t, ke na?tl as tilt- folludiltion 111)(11)
which to d? cel?ip ti,?' !,. al,h rt?t.int at.?l fill u.? health -(mire V r the nulividnal
emplovee nitltin tit-, al-encl.
c) The l,r?fr--ior.al per-or r .?1 ,-f tl.? health unit con>tilt with titt? chiployte
regarding the rec?trd.?ti firlt!ir-- at the 'iine of the health exami'iatio?1 in accord-
wive with file ph\ itiar- d:ncti II-: le?altIt In(atiit a.d itiitia.,et?. t?igether
with perintlit- f^llot+-up, It(- i- rrit,l out by- the phv-ician and the nur+4 ur> an
individual a'A per'ue ali'ed t?a. is to facilitate effective f,Wctionit.g of tilt individ-
ual, and of the group.
d) The prcctnpl,.vinett health record contain the foll?,wiag:
(Il Mitt?ial and , (i(ltati??nal hiMtor%;
(2) medical and lentai t:i?t?,rv;
(3) current. dental II ritI r et;
(4) che-t X raw rep' ri;
($) current medical find.nh- ; ??n,atic amt t?a}cl;i.?`
(6) uririalt ~ rt -fiorl;
(7! hlot,d -4-r- IoK% rn?I?ort
(S: hert:atology rep.ri (whin in,lit?ar..1
(9) an exprt-i.itl tf tilt- i,li}"r.c:ati% ?!liit.iurl regarding the (tii,il(,%?Pe's
prohaLle capacity fur rink ir,g a ;ar,fat?.,r} adjuwuent to the prt,pt*(?d job,
and'or to other ettiploj nu nt.
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otember 15, 1946 1650
c) The practice lx? initiated aid continued whereby the niettical recon14 are
regarded as confdciitial medical information anti an ntter?prelation of ftnding~
i - Q i \ t ` t l to Irer~ollnei ait.l r t L r t;lL;t'!C.Ia t` tIit?i;tii i~l!t It ante a, d 1.s.rablt' for rnt,rt -
effectite utilization of ntanponcr as related to: the employees' adjustment to the
j ii'; job placement; job a(lit:.iti t nt ; and maintenance of indiN reuse and nronp
htmlth.
I) Sustained collaboration be maintained between the pltysicia.i, industrial
hygiene personnel and the safety engineer, in the study of the total physical
work cti' i;onment of each group of workers for fete (Deport u,g purj,u.es:
(1) to determine the nature and extent of hazard, which are prc~ent. or
believed to he intiiiint? it;
(2) to plan. initiate, and secun? appropriate action for correcting arc
hazardous situation.
g) The physician be charged with an industrial physician's share of responsi-
bility for detecting the presence of specific occupational hazards, and the presence
of tangible and intangible factors within the work et.Nirontuent uloch are
capable of having a deh?tcrivus t?tTect upuui the lionith of the worker and his h?et?1
of productivity.
h) The physician be charged with an industrial physician', share of responsi-
bility for discovering nee 6, recommending specific rneastrre', ann jointly i titiating
appropriate action for correcting conditions requiring attention.
s) The physician be charged with the full retponcibility of a uredical special-
ist in maintaining sustained collaboration and cooperation between the health
unit and other appropriate pcrEnnnel of the agency or department, and in pro-
viding the employee with an optimal work environment.
,f) The physician and professional staff of the health unit be charged with
the responsibility of maintaining a sustained health-education program for the
employee population, anti separate groups there.,(. Appropriate health-ednerttion
activities be planned, initiated, and carried out by the medical, dental, nur.ing,
sad other appropriate pnrfessiortal personnel of the health unit.
k) An industrial mental hygiene program be promoted which is directed
at better jtth adjttstrnent for employees and better placement of employees, con-
cerned with the fitting together of the emotional demands of the job and the
emotional assets of the employee. This should be done through a program of
education and supemisiuu, at all levels in the functional organization of the
agency.
Such programs be carried out with the collaboration and cooperation of the
personnel staff.
1) Programs of case finding, comnttmicable disease control, special campaigns
such as mask, chest X-ray examinations, and similar activities be platutetl, initiated
and carried out by the professional staff of the health unit for the employee
population of the agency.
2. Diagnostic and advisory service include:
a) Professional evaluation of the employee's symptoms; deterrpination of the
true nature of his problem; determination of the significance of his problem in
relation to:
(1) the employee;
(2) the employee group;
(8) production levels;
(4) the community;
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1G51 Noremt-r 15. 1943
b) Guidance of the employee into a faller understanding of:
(1) his problem;
(2) ways of dealing with 1u= problem:
(3) resources available to hint for his use in dealing with his problem:
(4) appropriate steps to he taken in dealing'with his problem.
c) Referral of the employee to physicians and tkntists of the employee's own
selection for treatment of illness; other than on-the-job illness and dental condition
requiring emergency attention.
(1) Utilization by the agency physician of the consultation services of the United
States Public Health '4-r% ice and other Federal and local resources. and effective
exchange of pertinent information between the agency's employees' health service
and the resources mentioned above.
e) Appropriate interpretation of the eunployee's problem to the superior officer
of the employee, and to appropriate personnel officers within the agency who
share responsibility for all, or part, of the situation.
3. Medical, dental, and nursing treatment provided to employees
include the following:
a) Immediate care of illness and injury incurred in the perforni>Fnce of duty
and/or proximately caused by the employment.
b) Subsequent care of such conditions as are a?.rthorized by the Bureau of
Employees' Compensation under the direction of properly designated authorities.
e) Care of on-the-job illnesses and dental conditions of noncompensahle nature
which require emergency attention.
d) Emergency care of the employee who is suffering from a serious noose rviee-
connected illness and,'or injury; and prompt arra'igeinent for farther medical care
for the employee by his private physician and/or dentist, or by a hospital,
e) Special treatments to the individual employee upon the specific request of
his local private physician or dentist. The medication an.l biologicals needed for
his treatment to be acquired by the employee at his own exper8se and supplied
by him to the health unit.
f) Professional consultation and health instruction by the physician, the
dentist, the nurse, and other appropriate professional 1>4'rsou1)el on matters
relating to ttic indi%idllal's maintenance of optinu-l health and well-being.
p) Dental treatment include:
(1) immediate care of illness and injury incurred in the performance
of duty and. or proximately caused by the employment;
(2t subsequent care of such conditions as are authorized I).%, and under
the direction of, authorities designated by the Bureau of Employees' Com-
pensation;
(3) preemployment and periodic oral examination and diagnosis;
(4) emergency dental treatnn?ntt necessary for the relief of pain and
infection;
(5) adequate recording of findings and recommendations;
(6) referral of the employee for further remedial and restorative care to
the private dentist of the etuployee's selection;
(7) dental health education.
Noit:.--The details concerning the scope and type of dental service to be
recommended by the Public Health Ss'rvive are being developed, and will
be presented at a later date.
h) The function of the nuring service include treatment, health counsel-
in heatth ('41ucatiou. and li4ti,o n, as well as administration. and op ration of
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the individual ant or gru;(p of health ,!n:t The nurse's r a ?r;sit.ility will
include perfonni:.g s ich ,ctrl . s a. the fo1 -raving:
(1) interviewing;
(2) health counseling;
(3) health instruction;
(4) case-firidir,g ar,d foilo t-rap on at, individual 1?aai ;
(5) treatnter,t of oil-the-job illness and dental eonditi?e rerl';iri';g ernrr-
gency attention accoriuig to standing orders, or other appropriate medical or
dental authorization;
(6) collaboration and participation in planning, initiatine and carrcing out
over-all health education programs, and programs of case-firebug on a
mass level;
(7) carrying out under the directions of the supervising physician Specific
phases of research relating to such as the following:
(a) program platning to improve metl.otLs;
(h) disease prevention;
(c) reduction of absenteeim;
(8) maintaining approved systems of records and regs,rts;
(9) compiling records and reports;
(10) cooperating with the physician and or the dentist during his exam-
ination, and/or treatment, of the indiv lual enl,lnee;
(11) appraisal and referral of ca.on to appropriate available resources;
(12) acting as liaison Is'tct1?en tii' (npio\r?e' and these re r'lire,?y;
(13) acting as interpreter, aud'or liaison, between the , tup!o~-,?,? and bi74
physician, and/or h;s dent i t ; between the agency pd, c'ician and the ertl,loctw;
b tween the agency phiciar. and appr,rpnate perary detenti"n of the en,pl..cee tvho
conies to the unit for health smite; and Prot iile a pnfe-ioually eorroel et,viron-
tnent.
b) Conserve the time anti energy of the emplnYee, and that of the p'r"n iiel of
the health unit.
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C) Provide maximum privacy for every employee during examination, tr' at-
ment, and iutcrvtew by the professional lersonnet of tiie health unit.
d) Provide an adequate reception and waiting room area.
e) Provide a uiIable office for each pt.y-ir?ian, Kith egnipnu'nt to itIe: ide the
following basic items:
I examination table;
I instrutueut cabinet;
I treatment table for holding equipment which is being need bx tl:e phv,i-
cian in examining and%or treating the employee;
1 do k;
2 chairs;
I mirror;
appropriate professional instruments and equipment; a curtain, .swinging
from overhead supports, to screen the examination table and to
provide a dre.sing room for the employee prior to and following
examination and/or treatment;
I water-toilet and lavatory;
1 coat closet.
n Provide yuitahle office and work space for each den(i-t which is adequately
equipped to fulfill the functions of the dent u t as set forth by the Act.
Details concerning t rps and quantity of d? ntal equipment to be recom-
mended by the I'uhlic Ilealth Service are being worked out and will be pre-
sent,crl at a later date.
g) Provide suitable treatment rooms, fully and appropriatel} (quipped for use
by the nurse while treating and/or interviewing the employee. Lach treat-
ment room be provided with, a lavatory fixture with hot and cold running water,
treadle controlled, and also a separate lavatory fixture for use by the employee
when receiving oral and throat treatment, such as mortthwashew, gargle(,, and
throat irrigation,; or into which other contaminated solutions mac be discarded,
such as solutions from hand soaks, etc. (Having soundproof trtatrnent rooms is
essential so that the employee may be provided with the opportunity to discuss
his problems of a more intimate nature while he is tieing treated for minor prob-
isms, and/or problems of less intimate nature.)
h) Provide at least one treatment room in excess of the numtwr of nerves to be
employed in any one unit (this is essential to provide space for treating employers
who require soaks and packs, but who need not retain a nurse in constant atten-
tion with them.)
i) If laboratory services are required within the agency's health unit, provide
a separate appropriately equipped unit or room to serve as a laboratory unit.
This unit be so designed and so aituated that the operator sill be screened from
view while working in the laboratory.
The problem of determining what is the most desirable plan for providing
laboratory and X-ray service as a part of the employees' health service of the
individual department, agency, or Government-owned and -controlled corpora-
tion is a problem which is unique for each individual and each specific location
and should be determined with reference to the degree of availability of other
appropriate facilities (Federal, State, and local), relative cost in dollars and
cents, in employee time and energy. and in the end results to be accomplished.
j') Provide a communal work space or utility room immediately adjacent to the
treatment rooms. This utility room space be equipped with:
(1) a work counter;
(2) running water (hot and cold) and sink and drainboards (treadle-
control faucets);
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(3) sufficient cabinet spaee to acecmt,.odatt communal equipment and
-took supplies;
(t) dt,k -parr for the -ta(f nor-e, at which to write rteords and cotuf,ile
report..:
(5) file cabitwts for filit,g ca=(, rt-cord- arijarent to the nurse's t1r a , 1Case
record, should l , e i t t cit nroyilnity to 0 ,4. treatment rooms and easily
aece--il,le tc tut nor-e -o that she mat rt ricw thu previon, tvtric., on the
rntpln)ot'-~ ea,e record Itefon? huutehin~, into treatment of his current prob.
lent. '1 (fist i- c..-ential itta-onrch a, group, of z~yntptont, are -igniftcxnt.)
kJ I'rotit!e the equivalent of two cornfurtal,It - rest rooms--one for malt ern-
ployre,; one for fettale employ-e,. lath room be equipped with an adequate
nuntt,cr of bud,,
1) Preside tssu contpleto toilet units--one for male, one for female, etnplove(-s.
m) Provide adequate Apace to accommodate the required ntmmbcr of clerical
worker=.
n) Provide neca,;ary storage space for e(tnipnu:nt and supplies; and provide
enough space for an adequate nuusher of file cabinets.
o) Provide a.onodpruof otfict for the chief nnrst, of -to' sufhicictit to perrnit
its use as a St atf-conference room.
p) Provide adequate office t;paee for all other profe=sioual personit) nl,n shall
be required to hold confere.ncts, or prepare written material, e. g. the assistant
chief nurse, the vi>itiug nurse, etc.
q) Provide a nurse-' dresaug and locker ruorn equipped with an adequate
number of lockers, chairs, dre.-ing tabus, minors, and a complete toilet and lava-
tory unit dockers to be of sttllicieut sizr to permit the acceptance? of heavy :,treet
clothes).
r) All health units be provided pith standard "Health Unit" eigns Ahich are
ea-ilv discernible and legible at a distance from every approach to the unit.
a) Each health unit be equipped with a drinking fountain.
2. In selecting the location of health units the folio-Aing features
be taken into account:
a) The health limit be centrally located, preferably on the first floor, near an
exit which ran be reached easily by automobile If the unit is located above the
ground floor, it be within easy accsss of elevators.
L) The unit be located in an area free from vibration and noise.
c) The unit be siuiated so As to permit expansion of facilities if and as the
need for expansion occurs.
d1 The space allocated for the health unit he compact and permit easy now
of work to eliutinate bottk;necka and hack-tracking.
e) The unit be well lighted aid have controlled ventilation and temperature.
3. The pervading; tune and quality of the total employees' health
service be that created by the influence of high professional standards
and a genuine interest in and rei.peet for the personality of the
individual employee.
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