ML20235D932

Rev 3 to TVA Employee Concerns Special Program Subcategory Rept 71300, Medical, Consisting of Vol 7, Mgt & Personnel Category

ML20235D932
Person / Time
Site:	Browns Ferry
Issue date:	05/15/1987
From:	Brown W TENNESSEE VALLEY AUTHORITY
To:
Shared Package
ML082340470	List: ML18033A547 ML18033A548 ML18033A550 ML18033A551 ML18033A552 ML18033A553 ML18033A554 ML18033A555 ML18033A556 ML18033A557 ML18033A559 ML18033A560 ML18033A561 ML18033A564 ML18033A566 ML18033A568 ML18033A571 ML18033A573 ML18033A576 ML18033A578 ML18033A579 ML18033A580 ML18033A581 ML18033A582 ML18033A583 ML18033A585 ML18033A586 ML18033A587 ML18033A588 ML18033A591 ML18033A598 ML18033A600 ML18033A606 ML18033A609 ML18033A611 ML18033A612 ML18033A616 ML18033A617 ML18033A621 ML18033A622 ML18033A623 ML18033A624 ML18033A625 ML18033A631 ML18033A633 ML18033A634 ML18033A635 ML18033A636 ML18033A637 ML18033A638 ... further results
References
71300, 71300-V07-R03, 71300-V7-R3, NUDOCS 8902210095
Download: ML20235D932 (58)

Text

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t TVA EMPLOYEE CONCERN 8 REPORT NUMBER: 71300 SPECIAL PROGRAM REPORT TYPE: Management and Personnel Subcategory REVISION NUMBER: 3 \\ l r~ TITLE: Medical PAGE 1 OF 28 REASON FOR REVISION: Incorporation of Revision 2 conuments from TAS. l 1 l PREPARATION PREPAR BY: YW / 8AdW bbh / SIGNATURE DATE REVIEWS N

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l SfCNATURE /[ ATE l \\ ( /f 3 /b 7 / DtTE I l SIGNATURE l CONCURRENCES "71444 CEG-H: Q m. n /U '*fd <* - /S ~d ) SRP: SIGNATURE DATE

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/ DATE APPROVED BY: ID $ N/A l ) ATE MANAGER OF NUCLEAR POWER. DATE ~ M P MANAGER g CONCURRENCE (FINAL REPORT ONLY) l

• SRP Secretary's signature denotes SRP concurrences are in files.

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m u m j a TVA EMPLOYEE CONCERNS REPORT NUMBER: 71300 SPECIAL PROGRAM FRONT MATTER REY: 3 ) PAGE i 0F vili Preface 1 This subcategory report is one of a series of reports prepared for the-i .4 Employee Concerns Special Program (ECSP) of,the Tennessee Valley Authority The ECSP and the organization which carried out the program, the (TVA). Employee Concerns Task Group (ECTG), were established by TVA's Manager of Nuclear Power to evaluate and report on those office of Nuclear Power (ONP) Concerns filed after that employee concerns filed before February 1, 1986. 4 date are handled by the ongoing ONP Employee Concerns Program (ECP). Each of the concerns was a The ECSP addressed over 5800 employee concerns. formal, written description of a circumstance or circumstances that an employee thought was unsafe, unjust, inefficient, or inappropriate. The mission of the Employee Concerns Special Program was to thoroughly investigate all issues presented in the concerns and to report the results of those investigations in a form accessible to ONP employees, the NRC, and j the general public. The results of these investigations are communicated l r element, subcategory, cat.egory, and' final. by four levels of ECSP reports: Element reports, the lowest reporting level, will be published only for ' /j those concerns directly affecting the restart of Sequoyah Nuclear Plant's reactor unit 2. An element consists of one or more closely related i An issue it. a potential problem identified by ECTG during the { issues. For p evaluation process as having been raised in one or more concerns. { efficient handling, what appeared to be similar concerns were grouped into elements early in the program, but lasue definitions' emerged from the evaluation process itself.. Consequently, some elements did include only one issue, but often the ECTC evaluation found more than one issue per element. Subcategory reports summarize the evaluation of a number of elements. However, the subcategory report does more than collect element level evaluations. The subcategory level overview of element findings leads.to an integration of information that cannot take place at the element level, This integration of information reveals the extent to which problems j overlap more than one element and will therefore esquire corrective action for underlying causes not fully apparent at the element lovel. To make the subcategory reports easier to understand, three items have been placed at the front of each report: a preface, a glossary of the terminology unique to ECSP reports, and a list of acronyms. Additionally, at the end of each subcategory report will be a Subcategory Summary Table that includes the concern numbers; identifies other subecogories that share a concern; designates nuclose safety-related. safety significant, or non-safety related concerns; designates generic applicability; and briefly states each concern. Either the Subcategory Summary Table or anothee attachment or a combination of the two will enable the reader to find the report section or sections in which the issue raised by the concern is evaluated. 4

TYA EMPLOTEE CONCERNS REPORT NUMBER: 71300 SPECIAL PROGRAM FRONT MATTER REY: 2 PAGE 11 0F viii The subcategories are themselves summarized in a series of eight category reports. Each category report reviews the major findings and collective significance of the subcategory reports in one of the following areas: management and personnel relations i industrial safety construction i 'j material control j operations quality assurance / quality control welding engineering A separate report on employee concerns dealing with specific contentions of d intimidation, harassment, and wrongdoing will be released by the TVA Office of the Inspector General. 1 Just as the subcategory reports integrate the information collected at the element level, the category reports integrate the information assembled in all the subcategory reports within the category, addressing particularly the underlying causes of those problems that run acroas more than one subcategory. 1 I A final report will integrate and assess the information collected by all i of the lower level reports prepared for the ECSP. Including the Inspectoc General's report. For more detail on the methods by which ECTG employee concerns were evaluated and reported, consult the Tennesses Valley Authority Employee Concerns Task Group Program Manual. The Manual spells out the program's objectives, scope, organization, and responsibilities. It also specifies the procedures that were followed in the investigation, reporting, and 1 closecut of the issues raised by employee concerns. J P I !I 1 .i -lI .. ~

U TYA EMPLOYEE CONCERNS REPORT NUMBER: 71300 SPECIAL PROGRAM FRONT NATTER REY: 2 J e PAGE 111 0F vili I ECSP GLOSSARY OF REPORT TERMS

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classification of evaluated issues the evaluation of an issue leads to one of the following determinations: ? \\ Class As Issue cannot be verified as factual Class 8: Issue is factually accurate, but what is described'is 'not a problem (i.e.. not a condition requiring corrective action) Class C: Issue is factual sad identifies a problem, but corrective action 1 for the problem was initiated before the evaluation of the issue l was undertaken Class D: Issue is factual and presents a problem for which corrective action has been, or is being.,taken as a rescit of an evaluation Class E: A problem, requiring corrective action, which was not identified by an employee concern, but was. revealed during the ECTG evaluation of an issue raised by an employee concern. collective slanificance an analysis which determines the importance and l consequences of the findings in a particular ECSP report by putting those fa4 tings in the proper perspective. concern (see " employee concern") l corrective setion steps taken to fix specific deficiencies or discrepancies l revealed by a negative finding and, when necessary, to correct causes in l order to prevent recurrence. l criterion (plural criteria) a basis for defining a performance, behavior, or quality which ONP imposes on itself (see also " requirement"). g element or element report an optional level of ECSP report, below the I subcategory level, that deals with one or more issues. employee concern a formal, written description of a circumstance or circumstances that an employee thinks unsafe, unjust, ineffieleat or inappropriate; usually documented on a K-form or a form equivalent to the K-form. t 1 I

4 TVA EMPLOYEE CONCIIRN5' REPORT NUMBER: 71300 SPECIAL PROGRAM FRONT MATTER REY: 2 PAGE iv 0F vili evaluator (s) the individual (s), assigned the responsibility to assess a specific grouping of employee concerns, findinre ; includes both statements.of fact and the' judgments made about those facta dcring the evaluation processt negative findings require corrective action,:.. Issue t a potential problem, as interpreted. by tha ECTO during the evaluation process, raised in one'or mort concerns. K-form -(see Memployee concern".)e roouirement a standard of performance,. behavior, or quality on which an-evaluation judgment or decision may;be based.. root cause the underlying reason'for a problem. l

• Terms essential to the progrow but which require detailed definition have been defined in the ECTG Procedure Manual,(e.g., generic, specific, nuclear safety-related, unreviewed safety-Significant question). -

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l u .VA EMPLOYEE CONCERNS REPORT N'JMBER: 71300 SPECIAL PROGRAM FRONT MATTER REV: 2 PAGE v 0F vili l l l l Acronyms AI Administrative Instruction l AISC American Institute of Steel Construction ALARA As Low As Reasonably Achievable ANS American Nuclear Society ANSI American National Standards Institute / ASME American Society of Mechanical Engineers ASTM American Society for Testing and Materials AWS American Welding Society BFN Browns Ferry Nuclear Plant BLN Bellefonte Nuclear Plant i CAQ Condition Adverse to Quality CAR Corrective Action Report CATD Corrective Action Tracting Document CCTS Corporate Commitment Tracking System CEG-H Category Evaluation Group Head CFR Code of Federal Regulations CI Concerned Individual CMTR Certified Material Test Report COC Certificate of Conformance/Compilance DCR Design Change Request DNC Division of Nuclear Construction (see also NU CON) e l 5me 1

~r I TVA EMPLOYER CONCERNS REPORT NUMBER: 71300 SPECIAL PROGRAM FRONT MATTER REY: 2 j PAGE vi 0F vill DNE Division of Nuclear Engineering DNQA Division of Nuclear Quality Assurance DNT Division of Nuclear Training DOE Department of Energy DPO Division Personnel Officer DR Discrepancy Report or Deviation Report ECN Engineering Change Notice ECP Employee Concerns Program ECP-SR Employee Concerns Program-Site Representative ECSP Employee Concerns Special Program ECTG Employee Concerns Task Group EEOC Equal Em'ployment Opportunity Commission i EQ Environmental Qualification EMRT Emergency Medical Response Team k EN DES Engineering Design ERT Employee Response Team or Emergency Response Team FCR Field Change Request FSAR Final Safety Analysis Report FY Fiscal Year GET General Employee Training HCI Hazard Control Instruction HVAC Heating Ventilating, Air Conditioning II Installation Instruction INPO Institute of Nuclear Power Operations IRN Inspection Rejection Notice

s-1 TVA RMPLOYRE CONCERNS REPORT NUMBER: 71300 SPECIAL PROGEAM FRONT MATTER RRY: 2 d PAGE vil 0F vill j 1 l L/R Labor Relations Staff I l M&AI Modifications and Additions Instruction i ~ HI Maintenance Instruction MSPB Merit Systems Protection Board l HT Magnetic Particle Testing NCR Nonconforraing Condition Report i NDE Nondestructive Examination i r l \\ \\ NPP Nuclear Performance Plan i NPS Non-plant Specific or Nuclear Procedures System NQAM Nuclear Quality Assurance Manual j 1 NRC Nuclear Regulatory Commission 1 NSB Nuclear Services Branch 1 l NSRS Nuclear Safety Review Staff NU CON Division of Nuclear Construction (obsolete abbreviation, see DNC) NUMARC Nuclear Utility Management e.nd Resources Committee i OSHA Occupational Safety and Health Administration (or Act) ONP Office of Nuclear Power OWCP Office of Workers Compensation Program I PHR Personal History Record i, PT Liquid Penetrant Testing QA Quality Assurance QAP Quality Assurance Procedures i QC Quality Control QCI Quality Control Instruction l l l s,- l l l \\ t l l l

f .v j k i TVA EMPLOYEE CONCERNS-REPORT NUMBER: 71300 'l SPECIAL PROGRAN FRONT MATTER REY: 2 PAGE viii 0F'viii -) QCP ' Quality Control Procedure QTC Quality Technology Corapany RIF Reduction in Force RT Radiographic Testing SQN Sequoyah Nuclear Plant SI Survelliance Instruction SOP Standard Operating Procedure SRP Senior Review Panel SWEC Stone and Webster Engineering Corporation TAS Technical Assistance Staff T&L Trades and Labor TVA Tennessee Valley Authority l l TVTLC Tennessee Valley Trades and Labor Councti I UT Ultrasonic Testing VT Visual Testing ) WBECSP Watts Bar Employee Concern Special Program I WBN Watts Bar Nuclear Plant WR Work Request or Work Rules WP Workplane \\ i ..] E 1

MEDICAL Subcategory Report 71300 ~ Esecutive Sumscry i This subcategory included 57 employee concerns whleh raised 17 issues, q Tho' general areas of concern were the quality and components of medical services provided by TVA, administration of the federal Employees Compensation Act (FECA), and IVA policies regarding the determination and application'of medically imposed work t' restrictions (medic 61 constraints), L v e-The' findings indicate that TVA'redical services escoed not only pertinent regulatory requirements, but prevalent indu'try standards as well. I A. comparison of the large number'(over 40,000) of visits to Watts Bar i medical facilities during the timeframe of the concerns of with the relatively small number (57) of. concerns argues that employees are-1 generally satisfied with their onsito medical services. Nevertheless, a i e few individuals had problems that left them feeling dissatistled. .l Many of the complaints, including s7me which had been previously investigated and resolved, were caused by a lack of employee Entwledge of TFA medical policy or of the rules governing the V8CA. Others arose because the employees felt they had been treated unfairly and did not know how or where to appeal their grievances.- Before this evaluation took place, the Office of Nuclear Power implemented training to better inform managers and supervisors about the TVA medical care program. No additional corrective action has been recommended as a result of this evaluation. l l 1 v. I \\ 4 1 3947T Page 1 of 1

TVA EMPLOYEE CONCERNS REPORT NUMBER: 71300 SPECIAL PROGRAM REVISION NUMBER: 3 t PAGE 2 0F 28 1.0 CHARACTERIZATION'N OF ISSUES 1.1, Introduction The Medical Subcategory includes 57 employee concerns which raised j 13 separate issues. The issues are grouped into three elements: Quality and Components of the Medical Program Administration of the Federal Employees' Compensation Act (FECA) Miscellaneous Medical Issues Y To locate the issue in which a particular concern is evaluated, consult the following attachments: Attachment A, Subcategory Summary Table Attachment B, List of Concerns by Issue All Management and Personnel Category concerns having a technical component (including all concerns designated Nuclear Safety-Related) are shared with the appropriate technical category for investigation snd resolution of that technical component. Report (s) sharing a concern with this report are identified in the entry for that concern on Attachment A. 1.2 Der,eriotion of Issues 1.2.1 Quality and Components of the Medical Program Issue 71301 - TVA Medical Treatment is Inadequate The concorre in this issue qttestion the quality of medical j service provided by TVA. Issue 71302 - TVA Medical Personnel Are Not Qualified t The CIs claimed that TVA medical personnel lack the necessary erodentials and training and are not qualified for their jobs. Issue 71303 - Inadeausto Medical Staff on Nir.ht Shift Two CIs complained that the medical staffing on third shift is inadequate because there is no physician on duty. P

l 1 TVA EMPLOYEE CONCERNS - REPORT NUNBER: 71300 SPECIAL PROGRAM REVISION NUMBER: 3 PAGE 3 0F 28 Issue 71304 - Insufficient Emergency Medical Eauipment Onsite The CI stated that the lack of previously available eye treatment equipment necessitated a trip to the hospital to remove foreign matter from his/her eyes. She/he also contended that a heart attack victim might have survived.had there been proper equipment available for emergency treatment. Issue 71305 - TVA Medical Does Not Accept Private physician's Medical Constraints The basic contention in this issue is that TVA ignores the recommendations of private physicians, especially regarding medical constraints. Issue 71306 - Health and Safety Trainina is Inadequate The CIs felt that employees are inadequately informed of the hazards presented by certain chemicals. Medical personnel should participate in safety meetings and educate craft in substance dangers, noise limitations, and exposure to harmful chemicals. Issue 71307 - Employees Who Falsify Medical Records are Retained The CI contends that an employee who falsifies his/her medical records to gain employment is not punished or terminated when the falsification is discovered. Issue 71308 - Employees Denied Access to Medical Records The CI felt that his/her medical records contained erroneous date and he/she was not permitted to' review the records. Issue 71309 - Inadeousto Physical Suitability Program and Health Standards This issue is based on a perception that medically unsuitable personnel are working onsite and therefore health standards are too low or are not being effectively enforced. l 1.2.2 Administration of the Federal Employees Compensation Act (FECA) J 9 e

~, i. (. TTA EMPLOYEE CONCEENS~ EEPORT NUMBER: 71300-SPECIAL PROGEAN EEVISION NUMBER: 3 PAGE 4 0F 28' +. h Issue 71310 - Iniured Employees Returned to Duty Too Soon a. The contention in this issue is that employees are returned j to full duty too soon following treatment for work-related

injuries, f

Issue 71311 - Slow Clain Processina and Inadeouste Compensation The contention in this issue is that it takes an extremely long time to receive compensation for injuries..and the 4 compensation is sometimes inadequate or incorrect. 7 Issue 71312 - Compensation is Uniustly Denied The CIs contend that their claims for compensation were-unjustly rejected or denied by TVA. Issue 71313 - Cisla Filina Information Purposely Withheld The CI alleged that medical personnel intentionally withhold information as to which forms are required for filing compensation claims and on how to complete the forms. 3 1.2.3 Miscellaneous Medical Issues i Issue 71314 - Truck Drivers' Health Affected by' Hazardous Materials The CI alleged that more than half of 57 truck drivers ) suffered various physical ailments caused by transporting ) hazardous materials. Issue 71315 - Unstable Employee in Sensitive Position This issue is based on a contention that an employee deemed unstable by co.lleagues is insa sensitive position. t i. Issue 71316 - Medical and File Cabinets are Unsecure The CI stated that medical and' file cabinets cannot be easily locked and can be left unsecure. Issve 71317 P,ersonnel Decartment Channes Medical Records I i The CI alleged that the Personnel Department makes unauthorized changes to medical records. f Io ' t u r A

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O' TTA IMPLOYEE CONCERN 8 REPORT NUMBER: '71300 SPECIAL PROGRAN REVISION NUMBER: 3 PAGE 5 0F 28 Issue 71318 - Concerns With Insufficient Information to Evaluate The following two concerns contained insufficient information to permit identification with an issue or to evaluate: PH-85-003-016 WI-85-044-001 2.0

SUMMARY

l 2.1 Summary of Issues The evaluator has reviewed all the information available on the concerns in this subcategory. The information pertinent to the. evaluation of the issues has been considered and incorporated in this report. q The issues in this subcategory question the quality of medical care, the qualifications of medical staff personnel, the adequacy of available medical services and fair and efficient administration of the FECA. Four miscellaneous concerns were each evaluated as independent issues. 2.2 Summary of Evaluation Process i The evaluation process consisted of research of pertinent regulatory i requirements and TVA policy documents, interviews of knowledgeable personnel, review of individual employee medical and compensation records, and review of previous investigation reports that responded to 22 of the employee concerns included in this subcategory. 2.3 Summary of Findinas None of the issues presented enough evidence to be verified as factually securate. Gathering additional evidence was very difficult as the names of the CIs were not releasable to the-evaluator. However, the findings did indicate the need for more effective communication with employees regarding entitlement and avenues of sppeal available to them. 2.4 Rgymary of Collective S!anificance ) i A comparison of the large number of visits to WBM medical facilities I (over 40,000) during the timeframe of the concerns, with the relatively small number of concerns (58) argues that WAN employees ere generally satisfied with their onsitu medical services. 1 i N 1 i 1 l .1

y-u 1 TVA EMPLOYER CONCERNS REPORT NUMBER: 71300 SPECIAL PROGRAM RRVISION NUMBER: 3 PAGE 6 0F 28 No regulatory requirement mandates the high level of medical service that TVA has chosen to provide at its nuclear sites. However, employees need to be better informed on how to obtain available I medical services and on how to appeal what they consider unsatisfactory service. i 2.5 Summary of Causes The concerns were caused by a lack of employee awareness of the medical services and benefits available or of the procedures for handling complaints and appeals. 2.6 Sununary of Corrective Action p-i The Office of Nuclear Power has implemented training for managers and supervisors regarding TVA medical care policy, the medical program, and administration of the FECA. This training is included j in the TVA Supervisory Training Program, which is required for all ] supervisors. { 3.0 EVALUATION PROCESS l 3.1 General Methodology j l The evaluation of this subcategory was conducted according to the ) Evaluation Plan for the Employee Concerns Special Program (ECSP) and { the Evaluation Plan for the Management and Personnel Group. The i j concern case flies were reviewed. Source documents were researched i and interviews were conducted to identify the requirements and l criteria appilcable to the issues raised by the concerns. The lasues were evaluated against the identified requirements and I criteria. A collective significance analysis of the findings was { done. Causes were determined for negative findings and corrective I action for negative findings was initiated or determined to be L already completed or underway. l 3.2 Speelfle Methodoloar Research for TVA policy and regulatory requirements or convaitments to NRC involved indepth analyses of the TVA Administrative Release i Manuals. TVA Medical Examiner's Guide, TVA Medical Examiner's Guide Documentation Flies, the TVA M eiston of Medical Services Historical Files, and Personnel History itecords of TVA medical staff. l u L_---------_-__---

TVA EMPLOYEE CONCERNS REPORT NUMBER: 71300 SPECIAL'PROGRAN REVISION NUMBER: 3 PAGE 7 0F 28 Interviews were conducted with personnel in TVA's Division of Medical Services Director's Office, with personnel in the Central . Area Medical Services, with personnel at Watts Bar Nuclear. Plant (WBN) Medical Office and Health Station.. and with the Work Injury Compensation Services (WICs) staff. Interviews were also conducted with personnel from the Duke Power Company, Carolina. Power and Light Company, Virginia Power Company, Alabama Power Company, National Aeronautics and Space Administration, General Services i l Administration, Veteran's Administration. Department of Interior. l and United States Postal Services. Computer analyses from the Division of Medical Services' Automated 1 Medical Records System were also conducted to determine clinical visits, treatments.,and disposition for duty of both employees and employment candidates at WBN. The investigation of program practices included reviewing medical and compensation records of concerned individuals who allowed their identities to be revealed by Quality Technology Company (QTC). This evaluation makes use of the results of previous investigative reports on 22 individual concerns. These earlier investigations were conducted' by Quality Technology Company (QTC) and by Frank D. Faires, Medical Administrator, from September 6,1985 to March 18, 1986. These previous investigations also included interviews with TVA medical employees and management personnel responsible for administering the Medical Program. } The WBN Medical Office and Health Station's adherence to TVA policy and regulatory requirements, and compatibility with other related industries or Federal agencies was reviewed Notet See Attachment C for a List of Reference Documents. See Attachment D for a List of Interviewees. 4.0 f2q{HQ 4.1 Quality and Components of the Medical Froaram Jackaround There are no regulatory requirements for providing medical treatments at a nuclear power site. However, under the provisions l 0 t J 1

a 4 TVA" EMPLOYEE CONCERNS REPORT NUMBER: 71300 SPECIAL PROGRAM REVISION NUMBER: 3 PAGE 8 0F 28 of the TVA Code VIII HEALTH SERVICES, " Occupational Medical and 7 Related Health Services." TVA: helps employees to attain or maintain required or desirable health status by providing medical counsel, health education. { treatment within limits described below, or referral to non-TVA sources of help. Consistent with the Federal Employees Compensation Act (FECA), j TVA provides treatment for service-connected injury or illness through its facilities and through cooperation with the Office of Workers' Compensation Programs, (OWCP) United States Department [' of Labor. Within the limits of staff and equipment immediately available, TVA provides first-sid and temporary treatment for employees and nonemployees suffering non-job-related injury or illness on TVA premises. TVA medical personnel and equipment respond as appropriate to any legitimate, reasonable request for emergency medical services to meet an emergency or life-threatening situation. Also according to TVA Instruction VIII HEALTH SERVICES, " Examination": Medical staffs of the Division of Medical Services provide treatment for occupational injury or illness within the limics of staff and faellities available and in accordance with rules and regulations established by the CWCP U. S. Department of Labor, t The employee remains responsible for obtaining non-TVA care for non-wort-related health problems. Every employee is encouraged [~ to establish contact with and utilize the services of a personal l physician or medical facility for care of off-the-job illnesses or injuries. :(n most instances, treatment of nonoccupational injury and illness is not considered to be a responsibility of the occupational health program. Assistance and available initial care will be provided in l emergency situations arising at work where prompt treatment is a generally accepted method of preventing or controlling injury and diseew(. To reduce lost time from work. TVA also may offer, during work hours. limited medical treatment for minor 4.

e TVA EMPLOYER CONCERNS REPORT NUMBER: 71300' SPECIAL PROGRAM REVISION NUMBER: 3 PAGE 9 0F 28 4 nonoccupational injuries and illnesses. An employee whose nonservice-related condition requires extensive treatment or is of major significance, is referred to his/her personal physician. TVA may offer services which will assist that physician in care of the worker. TVA provides medical treatments for nonservice-connected injuries within the limits of staff and facilities, and also in emergency situations. Also within the limits of staff and time, TVA may provide medical treatments for employees with service-connected injuries if the injured employee requests so under the provisions of FECA. From October 1, 1985 through June 30, 1986, there were 21,871 employee visits for clinical services to the DNC WBN Medical Office, of which 7,599 were for the purpose of medical treatments. Of the 7,599 treatments, 4,439'(58%) were for nonservice-connected injuries or illness, and 3,160 (42%) were for treating service-connected injuries or illnesses. Of the 3.160. IVA successfully treated 2,943 (93%) visits having to refer 217 (7%) for outside treatment. During the same time period, there were 18,417 employee visits for clinical services at the permanent plant WBN Health Station, of which 8.632 were for the purpose of medical treatments. Of the 8,632 treatments, 7,010 (81%) were for nonservice-connected injuries or illnesses, and 1,622 (19%) were for treating service-connected injuries or illnesses. Of the 1,622. TVA successfully treated 1.566 (97%) visits having to refer 56 (3%) for outside treatment. j i Had these medical treatments for nonservice-connected injuries,or illness not been available to employees, most employees would either have had to suffer through their allment, taken a day of sick leave, or missed a day of pay. In addition, they would have incurred out-of-pocket medical expenses. for the treatments. 4.1.1 Issue 71301 - TVA Medical Treatment is Tnadeousto The CIs raising.this issue contend that medical treatment given by TVA Medical Services is inadequate in terms of the quality of treatment received. D_it w itsn The three conteras in this issue alleged (1) potentially ineffective medical trettront provided for on-the-job injury, (2) negligeat hendling of a job-related injury, and (3) failure to see a braken bone in initial s-ray, which resulted in improper treatment and a continuing problem. t J ____m__

1 ) TTA EMPLOYEE CONCERNS REPORT NUMBER: 71300 SPECIAL PROGRAN [ REVISION NUMBER: 3 ) i PAGE 10 0F 28 i Two of the concerns contained ins 2fficient details to allow investigation of the specific cases. (names of: the. individuals ) { were not available to the evaluator). The third concern was previously. investigated by a medical services staff member and a response was provided to the individual. (, Medical per'sonnel were interviewed and medical flies were i researched to determine the extent of compliants about the quality of medical services provided to employees. No record I' of such complaints was found, except the case of the f allegedly misdiagnosed broken' wrist cited above. .j j Conclusion j } The investigation found that the issue of inadequate medical treatment is not supported by the evidence and therefore was j not found to be factually accurate. Nevertheless, it is always possible for medical specialists, or any other specialist to make an error in judgment or an incorrect diagnosis. If an employee feels that the treatment received is inadequate, he/she may discuss the situation with the i physician or chief nurse at the facility. If no resolution is achieved, the situation may be appealed to the Area Chief Physician and, if necessary, to the TVA Medical Director. Also. FECA provides that employees who suffer job-related injuries are entitled to an initial choice of physician for treatment. An employee's choice of treatment by a TVA medical facility is not considered as an initial choice under FECA. If dissatisfied'with TVA treatment,'an employee still may choose a private physician to provide treatment under FECA. f 4.1.2 Issue 71302 - Qualifications of Medical Personnel The CIs claimed that TVA medical personnel lack the necessary { credentials and training and are.not qualified for their jobs. ~. Discussion t TVA requires its physicians to be graduates of American. Canadian, or othee accredited medical schools. Although Federal Government physicians are not subject to state licensure laws. TVA also requires its physicians to hold a license to practice medicine in the United Status. This evaluation determined that each license registration has been properly renet ed. Beyond basic licensure, several TVA physicians are certified by medical spec!alty boards. i k. =.

b TVA EMPLOYEE CONCERNS REPORT NUMBER: 71300 SPECIAL PROGRAN REVISION NUMBER: 3 i PAGE 11 0F 28 n .The medical staff includes two medical school graduates who do not hold state licenses, but neither works, nor is classified, as a physician. Until recently, both were J classified as Physician Assistants SE-6. One of them is now on the management schedule working as a clinical coordinator of workers' compensation and rehabilitation cases. All WBN's nursos are registered professional nurses with ) current state licenses. Occupationni nurse practitioners are required to have a minimum of ten months experience before i l being hired by TVA; occupational staff nurses are required to have at least 18 months prior experience in public or j occupational health nursing, including at least one year of ) l clinical nursing. Construction Public Safety Service officers, who assist nurses on ambulance runs, have received emergency medical training that meets State standards for Emergency Medical Technician qualifications. Their training includes first aid, resuscitation, and other ehersency techniques. In addition to their basic professional training and experience, the WBN physicians'and nurses have completed special training in emergency care and special training in handling radiations accidents from REAC/TS at the Oak Ridge Associated Universities. Conclusion g A review of pertinent regulatory requirements. TVA policies, and personnel files revealed that all TVA medical professionals have the required education, licenses, and special training and are fully qualified for their positions. Therefore, this issue was not verified as faccual. { 4.1.3 Issue 71303 - Inadequate Medical Staff on Night Shift Two CIs complained that the medical staffing on third shift is inadequate because there is no doctor on duty. l 4

TVA ENPLOYEE CONCERNS REPORT NUMBER:. 71300 SPECIAL PROGRAN REVISION NUMBER: 3: PAGE 12 0F 28 ) Discussion f The second and third shifts at the WBN Medical Office have one occupational health nurse on duty when construction is occurring during those shifts. -At the WBN Health Station, at i least one occupational staff nurse is on duty on all shifts. seven days per week. Although there is no physiclan'on duty during. third shift, the staffing is considered to be adequate. All TVA nurses are. fully trained to handle emergency situations. They'are l assisted by Public Safety officers who have received l estensive training in emergency medical techniques (see. i 4.1.2).. There are at least five trained personnel assigned on each shift including on weekends. to respond to medical emergencies. I In' addition, the TVA project physician is "on call" to receive requests for assistance and advice for any medical emergency. The onsite Health' Physics staff is.well trained j to deal with radiological emergencies ar.d we have agreements-with consnunity hospitals and the REAC/TS Center at Oak Ridge to provide prompt response to such emergencies. The WBN Medical Office. Health Station, and ambulances are equipped with state-of-the-art emergency instruments, supplies, and equipment but we do not, of course, have all the capabilities of a hospital emergency. room. Patients with life-threatening injuries or illnesses are given.the necessary first-aid and life support treatment and i insnediately transported to a hospital. just as they would be 1 on day shift. Conclusion I The investigation found that the medical staffing during night shift is adequate. A physician is not required because the nurses and public safety officers on duty are capable of i properly handling medical emergencies. Therefore, this issue was not found to be factual. 4.1.4 IsJuo 71304 - Insufficient Emergency Medical Equipment Onsite The CI stated that the lack of previously available eye treatment equipment neeersitated a trip to the hospital to remove foreign matter from his/her eyes. Che/he also i contended that a heart ateset victim might have survived had there been proper aquipmenc available for emergency treatment.

~, ? j TVA EMPLOYEE CONCERNS REPORT NUMBER: 71300-SFECIAL PROGRAN REVISION NUMBERt 3 q PAGE.13.0F 28 Discussion ]l .During the first 10 months of FY 1985, the'WBN Medical' Office 1 '. I had 376 employee patients with foreign bodies; most of which' were in the eyes. The medical staff was able to effectively { remove 336 of these foreign; bodies and return the employee to . l work.. It was necessary to refer 40 employees (10.6%) to outside' specialist who have specitity training in' ophthalmology because the foreign body was deeply embedded. Before he retired in July 1983, the previous project ] physician, Dr. Robert Hicks, was able to remove most deeply embedded foreign bodien because he had additional training and practice in ophthalmological techniques. None of our l I current physician staff has this specialized training or experience. There are no regulatory requirements to provide such a high degree of ophthalmological capability, nor is it TVA policy to do so. It was previously available only because of Dr. Hicks' unique qualifications and willingness to provide the service. Records indicate that on April 16, 1983, medical personnel responded to an emergency call for an apparent heart attack victim. Upon arriving at the scene, the nurse assessed the condition of the patient and could find.no pulse or other vital signs' The response team started CPR which was continued while the victim was being transported to the hospital. Unfortunately, the victim's condition was such that none of the emergency techniques could restore.his pulse and breathing and he was pronounced dead on arrival at the hospital emergency room. Conclusion Neither of the incidents referenced in the concern that raised this issue resulted from a lack of equipment that is required by regulations or should reasonably be expected to be available. While it is arguable that the heart attack victim may have survived had more or better equipment been available, that contention is not supported by the evidence. Therefore, this issue was not found to be factually accurate. 4.1.5 Issue 71305 - TVA Medical Does Not Accept Private Doctor's Work Restrictions The basic contention in this issue is.that TVA ignores the recommendations of private doctors, especially work restrictions. e

l ~ TVA EMPLOYEE CONCERNS REPORT NUMBER: 71300 SPECIAL PROGRAM ( REVISION NUMBER: 3 ( PAG 8 14 0F 28 Discussion TVA realized early in its existence the need for matching an employee's health condition with the requirements of the ' job. Physical examinations of applicants for employment became mandatory in 1934, and medical constraints (then known as work restriction codes) were developed to ensure that appilcants were placed in work they were physically capable of performing. These constraints were also applied to i employees who subsequently developed conditions which rendered them less able to perform their assigned jobs. { According to the TVA Medical Examiner's Guide, a " medical disposition for duty" is assigned an examinee and that 1 disposition will be either " approved," " conditionally approved " or "not approved." A conditional approval is given for an individual if he or she has a health impairment which limits but does not preclude medical approval for the l duty proposed. Medical constraints are placed upon ) individuals who are conditionally approved to " inform responsible management that speelfic acconunodations may be required to enable the individual to perform the full range of pertinent job title and special duties safely and effectively." According to the GUIDE, medical constraints are developed with input and close coordination from the individual, the individual's private physician, and the individual's TVA supervisor or manager. TVA management must specify relevant performance requirements and realistic hazards of the job. The TVA medical examiner makes the final decision when applying medical constraints since occupational health physicians are more fully aware of occupational health hazards than medical constraints. I One of the concerns in this issue was previously investigated by a TVA medical administrator and the situation was resolved. The WBN physician, upon learning that different i medical constraints had been recommended by a private physician, asked the private physician to confirm his l recorsnendat ions. This consultation resulted in acceptance of the privata physician's recommended medical constraints. g f ~. g mew ,a e na

TVA EMPLOYEE CONCERNS REPORT NUMBER: 71300 SPECIAL PROGRAM REVISION NUMBER: 3 PAGF 15 0F 28 As with disagreements concerning medical treatments, employees may discuss application of medical constraints with the physician at the local facility. If no resolution is achieved, the situation may be appealed to the appropriate Area Chief Physician. Following review by the Area Chief Physlalan, a review by TVA's Medical Director is required if the employee is dissatisfied with the Area Chief Physician's determination. Throughout the appeals process, the employee is encouraged to engage the active participation of his or her private attending physician. i conclusion The TVA medical examiner does make the final decision regarding work restrictions However, the employee's private physician's recommendations are fully considered, along with input from the employee and his/her supervisor or manager. Therefore, this issue was not verified as factual. 4.1.6 Issue 71306 - Health and Safety Training is Inadequate The CIo felt that employees are inadequar.ely informed of the hazards presented by certain chemicals. Medical personnel should participate in safety meetings and educate craft in M substance dangers, noise limitations, and exposure to harmful chemicals. 4 Discussion l There are no regulatory requirements for health education. However, according to TVA Code VIII HEALTH SERVICES, " Occupational and Related Health Services " TVA: helps employees to attain or saaintain required or desirable health status by providing medical counsel, health education, treatment within limits described below, or referral to non-TVA sources of help. TVA nurses conduct any management-requested special health education programs for employee groups and provide health counselinL and eoucation services to indivioual employees to I promote health maintenance ar.d restoration. I According to the Ottan!zatic s Bulletin. I Corporate Services, " Division of Occupitio7a1 Health anG Uafvty"; 1 I I

TVA EMPLOYEE CONCERNS REPORT NUMBER: 71300 SPECIAL PROGRAM REVISION NUMBER: 3 PAGR 16 0F 28 e. l The Division of Occupational Health and Safety has corporate responsibility for formulating TVA occupational health and safety plans and policies. It develops and l 1ssues criteria and standards for control of hazards in the workplace... It develops and administers safety l 0 promotion ' Recognition, awareness, and incentive programs I and materials as requested. It provides both technical and orientation health and safety training support to line management as requested. / Conclusion Medical personnel are not responsible for determining health r k and safety requirements; they conduct training regarding ) medical topics only upon request by management. Therefore. l this issue could not be verified as factual. j t Employees who would like to receive health and hazardous l materials education should request so from their supervisor i who is responsible for making arrangements with presenting j organizations such as the Division of Occupational Health and 4 Safety or the WBN Safety Engineer. Additional information about occupational health and hazardous materials issues may be found in Industrial Safety Subcategory Report 912. Industrial Hygiene. 4.1.7 Issue 71307 - Employees Who Falsify Medical Records Are Retained The CI contends that an employee who falsifies his/her l medical records to gain employment is not punished or terminated when the falsification is discovered. Discussion I On each TVA medical examination / evaluation form, a I l certification statement is added to ensure the employee j truthfully answered each itenr. The most coninon statement is: s I certify that I have truthfully answered the foregoing 1 f questions to the best of my knowledge. I further certify l I that should I develop a health problem or be placed on medication that might interfere with my ability to safely l perform my duties, I will immediately notify my I supervisor. l l l 1 l L

t TVA EMPLOYEE CONCERNS REPORT NUMBER: 71300 SPECIAL PROGRAM REVISION NUMBER: 3 PAGE 17 0F 28 \\ When it becomes known that an employee has falsified a { medical record, the procedure below is carried out. A h memorandum dated November 20, 1981, " Falsification of Medical i Record Information" from Frank D. Faires. Medical Administrator, states: Confileting Information Uncovered At Time Of Employment f Processing Call the candidate's-attention to the information just given by the candidate that conflicts with the previous record and make sure that the correct information-and conflict is considered by the medical examiner and recorded in the medical record. Confileting Information Uncovered After The Employee Is On The Job If the correct information indicaten there may be a concealment of a health and safety threat, immediately call l the employee's official supervisor or other appropriate authority and have the employee sent to medical for re-evaluation. Based on that re-evaluation, initiate l appropriate medical disposition for continued duty, holding off duty, etc., and telephone me about the situation as early as possible. If the situation does not constitute an i immediate health and safety threat, telephone me about the i case as soon as possible. In cases where it appears there has been a deliberate and flagrant falsification of important medical information, I will refer these to the Personnel Security Officer for administrative disposition. The Personnel Security Office in TVA's Division of Personnel then determines. on an individual basis, whether the falsification warrants termination. If employees suspects or has information that indicates that another employee has. falsified his or her medical record, they should contact the chief nurse at their local medical facility who will review the situaticn and notify the Medical Administrator as appropriate. } Concluolon The evaluation found that sound procedures for dealing with medical records falsifiestion do exict and may result in termination. Therefore, this issue was not verific'd so factual. Y ______E.___.1____.__._

__-_ 7 TVA'EMPLOTEE COMCERNS REPORT NUNBER: 71300 SPECIAL PROGRAN REVISION NUMBER: 3. l .PAGE 18 0F 28 p 4.1.8 Issue 71308 Employees Denied Access to Medical Records The concern in this issue stated only that erroneous.. data.had been placed in the CI's medical records..Upon consultation with QTC, it was. learned that the CI's real concern was that he/she was' denied access to the records and could not, l therefore, determine whether the records were correct. 6 l Discussion c' f According to the TVA Code. II PRIVACY, " Protection of Personal Privacy": f-l 't TVA permits an individual, except as authorized by law, to I ascertain what records pertaining to that individual are i maintained by TVA in TVA systems of records, to gain. c access to and to request correction or amendment of such records. In addition. TVA Instruction II PRIVACY.." Procedures" provides that: If in the judgment of the Division of Medical Services the transmission of medical records, including psychological records, directly to a requesting. individual could have an adverse effect on such individual. TVA may refuse to provide such'information directly.to the individual.- TVA will, however, provide this information to a licensed physician designated by the individual in writing. Conclusion The investigation revealed that employees have unrestricted access to information in their medical records except for that information which could have an adverse effect on the 3 Individual. In that case, the records would be released to a a private physician designated by the employee, if requested; ] I f [ therefore, this issue could not be verified as factual. l l 4.1.9 Issue 71309 - Inadequate Physical Suitability Program and i Health Standards ( This issue is' based on three employee concerns. One CI feels there are some WBN persennel who are physically unable to j perform their duties and thinks a physical suitability l I l l 4 t l 1

w. TVA EMPLOYEE CONCERN 8 REPORT NUNBER: 71300 j SPECIAL PROGRAM J { REVISION NUNBER: 3 PAGE 19 0F'28 U program'would help. Another CI asked what medical standards are used to evaluate an employee's " condition to work." The' - third CI alleged that a particular. crane operator has had a' heart attack and open heart surgery.. These three concerns, taken together, seem to question whether TVA has an.d enforces a physical suitability program.. ' Discussion Medical Services personnel and representatives of TVA l employment offices were interviewed-to determine what policy. requirements and procedures were appilcable and to what degree the requirements are enforced.' The findings from those interviews are outlined below. According to TVA CODE VIII HEALTH SERVICES. " Occupational Medical-and Related Health Services":f j Physical and mental health adequate for-safe'and efficient performance of assigned duties is a condition of TVA' employment. The medical suitability of employees and candidates for employment at TVA is determined by relating each individual's physical and mental capacities to specific job requirements. Employees, employment candidates. and certain temporary ( assignees are examined to determine their. capacity to work ? safely and efficiently within the specific-health (. requirements of the job. Candidates for employment are referred to a TVA medical office by TVA Employment Offices using a form TVA 9880A. " Appointment Affidavit and Conditions." Employees are referred to a TVA medical office by TVA management or supervisors using a form TVA 1444 " Request for Examination." These two forms outline to-the TVA medical eneminer the speelfic job for which the person is applying and.any special physical conditions necessary for employment. l' TVA medical examinations are conducted according to the two-volume TVA Medical Es.ggigtr's Guide. In addition to general employee medical examinations, the ggigg outlines is Y. i

.0 TTA EMP14YEE CONCEENE REPORT NUMBER: 71300 SPECIAL PEOGIAN EETISION NUMBER: 3 Iu PAGE 20 0F 28 procedures.for special medical examinations. These f examinations are for candidates whe:1must comply with 1 legislative, regulatory, and/or other requirements for determining special capacities or abilities required for I duty, to assess medical qualifications.for licensure for duty, or to monitor health factors related to control of f-specified occupational hazards. Initial and re-employment osaminations conducted at W8N from j January 1, 1984 through June 1, 1986 totaled 979. From these i 979, 798 (81%) were approved for duty, 172 (18%) were approved for duty with medical constraints, while less than 1% (9) were not medically approved for duty. ( j Conclusion I I The evaluation revealed that TVA has an extensive physical suitability program and specific health standards that are rigidly enforced. Therefore, this issue was not verified as factual. 4.2 Administration of the Federal Employees Compensation Act (FECA) 4.2.1 Issue 71310 - Injured Employees Returned to Regular Duty Too Soon This issue claims that CIs are put back on regular duty too soon after injuries or extensive surgery. Discussion Before the advent of the rehabilitation program, employees with job-related injuries were left in leste status until l they had fully recovered. When an employee was able to j perform productive work, the policy was to try to find a suitable position for him or her.- f In 1972, a formal vocational rehabilitation program was established, with emphasis an rehabilitation of compensation recipients. The current Recovery Track Program is designed l to return workers to their original jobs by assigning them to l l 4 o 1 i l L

~, i TVA EMPLOYEE CONCERNS REPORT NUMBER: 71300 SPECIAL PROGRAM REVISION NUMBER: 3 PAGE 21 0F 28 ) 1 special light-duty tasks during the recovery process. The I program emphasizes injured workers' espabilities rather than limitations, and includes close coordination with the workers' private physicians. The Vocational Evaluation 1 Program helps impaired workers to determine suitable job placement and training goals and to implement their goals. Vocational rehabilitation is beneficial to injured workers because it helps speed their return to full duty and, thus, to full earnings status. It also helps TVA reduce compensation costs and make better use of available l compensation resources. TVA's program was cited by both the Congressional Committee on Government Operations and the Department of Labor Inspector General for its effectiveness l In restoring injured workers to their former status. Conclusion Any employee who is dissatisfied with the handling of his/her l l rehabilitation is encouraged to consult with the responsible TVA physician, private physician, and rehabilitation counselor. If necessary, further appeal may be made to the Area Chief Physician, then to the TVA Medical Director if still not satisfied. The identities of the CIs who were dissatisfied with the speed of their return to duty was not released to the g evaluator; therefore, an investigatten of specific ceses was not possible. The issue as a whole was not verified as 4 l factual. 4.2.2 Issue 71311 - Slow Claim Processing and Inadequate Compensation The contention in this issue is that it takes an extremely long time to receive compensation for injurias, and the compensation is sometimes inadequate or incorrect. Discussion According to TVA Instruction VIII INJURY, " Employee": 1 TVA employees who sustain injuries or illnesses in the performance of their official duties are entitled to compensation and other benefits in accordance with provisions of the FECA. This Act is administered by the i I 1 L

TVA EMPLOYEE CONCERNE REPORT NUMBER: 71300 SPECIAL PROGRAN REVISION NUMBER: 3 i PAGE 22 0F 28 OWCP, U.S. Department of Labor. OWCP reaches decisions about and awards benefits for all occupation-related l' injury or illness claims submitted-by Federal employees. The Division of Medical Services acts as liaison with OWCP to provide or ensure that TVA employees receive the benefits to which they are entitled under the Act. The Work. Injury Compensation Services'(WICS) staff in TVA's Division of Medical Services manages TVA's participation in the administration of FECA benefits. Essentially, a11' claims J f are submitted through the WICS and that staff handles all. correspondence with OWCP about particular. claims s'nd the l ( administration of FECA. The claims management, service is coordinated with and l J supported by other elements of TVA's occupational medical i services program, including medical evaluations and management and the rehabilitation program in particular. I In 1981, the average lapsed time from an employee's initial notice of a traumatic lost-time injury to transmittal of a documented initial claim by TVA to OWCP was 48 days. By 1985, that time interval had dropped to 15 days TVA-wl'de -- a decrease in time of over 69 percent. At WBN, the process interval was 16 days by 1985. FECA sets specific compensation rates including death benefits. According to TVA Instruction VIII INJURY, " Employee," FECA rates are set us follows: The basic rate of compensation is 66-2/3 percent of the I rate of pay, esclusive of overtime, at the time of injury. If the injured employee has one or more l dependents, the basic rate of compensation is augmented'by 8-1/3 percent. The monthly compensation can neither j exceed 75 percent of the highest step of grade 15 of the j current General Schedule of the Classification Act of i l 1949, nor can it be less than the lowest step of grade 2 of the schedule (see PM Section 2. Federal Service General 1 Schedule) for temporary or permanent total disability unless the employee's monthly pay is less, in which case e i the monthly rate of compensation shall be equal to the 1 employee's full monthly pay.. i a i i i t

4 TVA EMPIAYEE CONCERNS REPORT NUMBER: 71300 SPECIAL PROGRAN REVISION NUMBER: 3 PAGE 23 0F 28 For a temporary employee who worked for TVA less than 90 percent of the year immediately preceding the date of injury and whose employment would have continued for less j than 90 percent'(234 workdays or 11 months) of the year had he or she not been injured, compensation'may be based on the employee's average annual earnings, provided such earnings shall consist of not less than 150 times the l average daily wage which he or she.shall have earned in such employment during'the year immediately preceding the injury. If an employee suffers a recurrence of disability a'rt e having returned to a regular,-full-time TVA job and worked for as long as six months, compensation is based on the l rate of pay at the time of injury or recurrence.of disability, whichever is greater. A review of previous responses to some of the concerns in this issue found only one case of delayed submittal by WICS. That claim had been misflied, in the wrong file cabinet. When the CI inquired about the claim, the error was discovered and the claim was submitted immediately to OWCP. In the other cases, claims were delayed by the employees' failure to submit information that had been requested either by WICS or OWCP to document the claims. Conclusion 3 TVA does not determine the amount of compensation due an -q 4 injured worker. Compensation rates are specified by the M FECA, which is administered by the OWCP. 17 A h 9 an excellent record for the timely submittal of claims to the CWCP, with an average elapsed time at WBN of 16 days from an employee's report of injury to transmittal of the initial claim. TVA-has no control over claims processing by the OWCPt however, the WICS staff is readily available to assist employees in following up their claims with the OWCP. Employees who feel their compensation claims are not being handled properly should contact the WICs staff in Chattanooga or, if necessary, the manager of TVA's Workers' Compensation Program Services. Based on the evaluation summarized above, the issue of slow claim processing and inadequate compensation was not verified as factual. l. '~

I s TVA EMPLOYEE CONCERNS REPORT NUMBER: 71300 SPECIAL PROGRAM REVISION NUMBER: 3 PAGE 24 0F 28 4.2.3 Issue 71312 - Compensation is Unjustly Denied The CIs contend that their claims for compensation were unjustly rejected or denied by TVA. Discussion Four of the eight CIs raising this issue have received previous responses to their concerns. In one of the caser, the CI had in fact received compensation for two separate i claims, and a third claim was under review by the OWCP at the l time of the response. The other responses told the CIs l l precisely how to get assistance'in filing and following up their claims. Interviews with WICS staff members and a review of compensation case files revealed that claims not paid fall into three categories: Claims for which additions 1 information has been requested of the employee, but not yet provided i l Claims that had been denied by the OWCP for cause j l Claims that had been contested (controverted) by TVA l as unjustified When a claim is submitted with insufficient information or l supporting evidence, the claimant is informed is writing of l the status of the claim and what information or evidence is l required. It is then incumbent upon the individual to submit I the required documents. The WICS staff and the WBN compensation clerk assists the employee in gathering the 1 required information and completing the necessary forms. I l When a claim is denied by OWCP, the employee is informed in writing of the reason (s) for the denial. The employee is also advised of his/her appeal rights and the procedure for I exercising those rights. A claim may also be denied as the result of a successful challenge by TVA. OWCP regulations give the employing agency the right to controvert claims that appear to be unjustified. Controvert means to submit formal objection with evidence. It must be supported by a concise, thorough, a

TVA EMPLOYEE CONCERNS REPORT NUMBER: 71300 SPECIAL PROGRAM REVISION NUMBER: 3 PAGE 25 0F 28 factual report including the rationale on wnich the objection la based. Claimants are informed when a claim is being controverted and are told the reason why. The OWCP may concur with the controversion and deny the claim or it may decide in favor of the claimant; in any event, the decision is made by the OWCP, not by the employer. As with any denial of a compensation claim, the claimant has the right to appeal the CWCP's decision to the U. S. Department of Labor Branch of Hearing and Review. The WICS staff and WBN compensation clerk assists employees in filing their appeals. Conclusion i ( It was not possible to investigate all the specific cases, as the names of the CIs were not available to the evaluator. However, the investigation indicated that claims are handled and determinations are made in accordance with the FECA and OWCP procedures. No cases of unjust denial were found. An individual may certainly disagree with e decision and consider it to be unjust. However, ample svenues of appeal are available, and l assistance is available Cor the asking. Therefore, this l issue was not found to be far,tual. l 4.2.4 Issue 71313 - Claim F11 Lag Information Purposely Withheld The CI alleged that medbcal personnel intentionally withhold information as to which Eorms are required for filing compensation claims and how to complete the forms. 4 Discussion The WICs staff in TVA's Division of Medical Services manages TVA's participation in Qbat administration of FECA benefits. Essentially, all claims see submitted through the WICs, and that staff handlea all correspondence with OWCP about particular claims and the administration of FECA. c Under FECA. every emp15yee who is injured in the performance of duty must give written notice of the injury on Form CA-1 within 30 days after its occurrence. This is a legislated or legal requirement in the ACT ltself. Also, to continue

v 1 1 a l TVA ENPLOYEE CONCERNS REPORT NUMBER: 71300 SPECIAL PROGRAM REVISION NUMBER: 3 l PAGE 26 0F 28 treatment and eligibility for compensation, various forms (just which ones depends on the situation'itself) must be ] l completed and submitted to OWCP by the employee. Someone j acting in the employee's behalf may initiate and submit the i required forms. TVA however, cannot initiate a filing for j compensation. l The WICs staff and other designated compensation specialists l are available to assist employees in completing necessary I forms. However, it remains the employee's responsibility to f take advantage of this assistance. j It is not possible to determine the precise reason for the I concern in this issue, as the identity of the CI is not known to the evaluator. However, the concern was previously investigated by a medical administrator.and a response was provided to the CI. That response referred the CI to specific persons for assistance and to the WICS staff in Chattanooga if any problems were encountered. Conclusion The investigation found that assistance is available to employees who need to file FECA claims, but it is the j employee's responsibility.to ask for help. No evidence was found of any WICs staff member or other compensation specialist refusing a request for assistance. Therefore, this issue could not be verified as factual. 4.3 Miscellaneous Medical Issues Each of these miscellaneous issues was previously investigated an a response provided to the CI. This evaluation concurs with the previous findings as sununarized below. t 4.3.1 Issue 71314 - Truck Drivers' Health Affected by Hazardous Materials b The CI alleged that medical problems of several truck delvers were caused by transporting hazardous materials. i ( Investigation revealed that the cited health conditions were congenital; therefore, this issue was not found to be factually accurate. 1 1 i 1

v o i TVA EMPLOYEE CONCERNS REPORT NUMBER: 71300 SPECIAL PROGRAM REVISION NUMBER: 3 PAGE 27 0F 28 4.3.2 Issue 71314 - Unstable Employee in Sensitive Position The CI stated that an employee in a sensitive position was considered unstable by colleagues. A previous investigation found the individual's condition to be medical, not psychological; therefore, this issue was not found to be factual. 4.3.3 Issue 71316 - Unsecure Medical and File Cabinets The CI stated that medical cabinets and flies cannot be ) completely locked and can easily be left unsecured. j 1 Investigation revealed the issue was factual but the cabinets I had already been replaced with ones that lock. f 1 1 I 4.3.4 Issue 71317 - Personnel Department Changes Medical Records The CI alleged that the personnel department makes unauthorized changes to medical records. l \\ The investigation revealed that no entries are made to l medical records by anyone other than tne Medical Staff. Documents relating to personnel action, such as hirings or terminations, are included in medical records but they have f no relation to medical actions. Therefore, this issue was not found to be factual. 5.0 COLLECTIVE SIGNIFICANCE During the timeframe of the concerns'in this subcategory, WBN medica' services had over 40.000 visits. The 57 concerns in this category were from a total of 49 individuals. That 40,000 visits produced only i 49 concerned individuals argues that WBN employees were generally I satisfied with their onsite medical services. All of this is not'to say that many of 49 CIs did not have genuine cause for irritation. The patients a_nj the medical staff at any American medical facility are overburdened with paperwork. The situation at WBN is not an exception. The evaluation indicates that some employees need to be bottor informed on what medical services and compensation benefits are due them and also better informed on how to obtain those services and benefits. They should also be better informed on the appeal processes available to them if they receive less than satisfactory medical service. Workers who feel they are being treated unfairly or indifferently are not likely to perform to their full potential. L_~______-__.._________

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'?. t TVA XMPLOYEE CONCERNS REPORT NUMBER: 71300 SPECIAL PROGRAN i REVISION NUMBER: 3 .j ~ PAGE 28'0F 28 a. i 6.0 CAUSES q f Some of the concerns in this subcategory appear to be based on l dissatisfaction with eititlements rather than denial of entitlement. l Others, however, appear to stem from a lack of employee awareness of what i f' medical services and compensation benefits are due them and how to obtain l l them. Employees are insufficiently aware of how medical constraints are determined, how to apply for FECA benefits, and how to appeal decisions with which they disagree. i 7.0 PREVIOUSLY INITIATED CORRECTIVE ACTIONS f The Office of Nuclear Power has implemented training for managers and supervisors regarding TVA medical care policy. Training will also be offered on TVA's occupational medical program and the administration of FECA and it provisions. This informative program is incorporated in the { TVA Supervisory Training Program and is required for all TVA supervisors j t as a corporate program, l Employees are also informed about medical programs by TVA publications j such as Inside TVA. TVA Today. TVA announcements and by means of paycheck inserts. 8.0 ATTACHMENTS Attachment A. Subcategory Summary Table Attachment B. List of Concerns by Element-Attachment C. List of Reference Documents I Attachment D. List of Interviewees I I f' l I 1 j L_ i l l I

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m 9 i ATTACHMENT B '~ MEDICAL List of Concorus by Elonent/ Issue f The Medical Subcategory (71300) is comprised of 57 concerns broken down into three elements addressing eighteen l'ssues. I' Ouslity and Components of the TVA Medical Protras I. Issue 71301 - TVA Medical Treatment is Inadequate E1-85-150-001 IN-85-876-101 ) EI-85-150-004 IN-86-033-001 ) IN-85-248-003 WBP-86-003-002 ~ IN-85-329 001 Issue 71302'- TVA Medical Personnel are not Quellflod f IN-85-248-006 00-85-005-006 IN-85-605-003 OW-85 007-001 IN-85-835-003 i Issue 71303 - Inadequate Medical Staff on Night Staff IN-85-284-003 IN-86-172-001 Issue 71304 - Insufficient Emergency Medical Equipment on Site IN-85-665-002 Issue 71305 - TVA Medical Does not Accept Private Doctors' Medical Constraints IN-85-335-003 IN-85 770-005 IN-85-674-001 PH-85-045-001 IN-85-723-001 WI-85-048-001 ) l Issue 71306 - Health and Safety Training is Inadequate IN-85-663-014 I IN-85-910-002 L IN-86-280-001 l 4. ] I L Page 1 of 3 i { L

ATTACHMENT B i j MEDICAL d List of Concerns by Element / Issue (Continued) Issue 71307 - Employees who. Falsify Medical Records are Retained ) IN-85-663-005 IN-85-810-X01* Issue 71308 - Employees Denied Access to Medical Records l l IN-85-241 009 Issue 71309 - Inadequate Physical Suitability Program and Health Standards IN-85-810-X01* IN-85-871-002 WBN-0218 Administration of the Federal Employees Compensation Act (FECA) Issue 71310 - Injured Employees Returned to Duty Too Soon IN-85-248-005 l l IN-85-539-002 WI-85-044-006 Issue 71311 - Slow Claim Processing and Inadequate Compensation EX-85-120-X01 IN-85-627-030 EX-85-149-001 'IN-85-901-001 .j IN-85-119-005 IN-86-256-001 L' IN-85-199-002 WSM-85-003-003 ,i + Issue 71312 - Compensation is Unjustly Denied EX-85-130-001 IN-85-923-001 EX-85-150-003 IN-85-996-004 EX-85-152-002 IN-86-162-002 IN-85-546-002 WBP-86-001-007-IN-85-821-007 VI-85-048-002 Issue 71313 - Claim Filing Information Purposely Withheld IN-85-725-004 1 1

• Concerns addressed in more than one issue Page 2 of 3

_j,

ATTACHMENT 8 MEDICAL [ List of Concerns by Element / Issue (Continued) t l Miscellaneous Medical Issues j ' Issue 71314 - Truck Drivers' Health Affected by Hazardous Materials IN-85-720-X05 . Issue 71315 - Unstable Employee in Sensitive Position l I IN-85-951-001 Issue 71316 - Medical and File' Cabinets are Unsecure i IN-85-539-001 Issue 71317 - Personnel Department Changes Medical Records ) PH-85-003-019 1 Issue 71318 - Concerns with Insufficient Information to Evaluate PH-85-003-016 l WI-85-044-001 } I Ii I l i I t Page 3 of 3 I u: _m ]

m u 4.IIAQHMENT.C J List of Reference Documents J l l TVA GENERAL RELEASES, ORGANIZATIONAL BULLETIN I CORPORATE SERVICES, Medical Services j TVA GENERAL RELEASES, II PRIVACY (Code) }" ^1 W TVA GENERAL RELEASES II PRIVACY (Procedures)' TVA GENERAL RELEASES, VIII HEALTH SERVICES (Code) TVA GENERAL RELEASES, VIII HEALTH SERVICES, Examination j i / TVA GENERAL RELEASES, VIII HEALTH SERVICES.. Facilities i TVA GENERAL RELEASES, VIII HEALTH SERVICES, Radiation ilorkers TVA GENERAL RELEASES,~VIII HEALTH SERVICES, Rehabilitation TVA GENERAL RELEASES, VIII INJURY l 4 TVA GENERAL RELEASES, VIII OCCUPATI0 rial HEALTH AND SAFETY (Code) ) TVA Medical Examiner's Culde Volume I, IV. Medical Disposition for f Duty TVA Medical Ezaminer's Guide, Volutae I V. Basic Categories of Examinations TVA Medical Examiner's Guide, Volume I, VI. Special Examinations for Specific Duty TVA Medical Esaminer's Guide, Volume I VII. Special Examinations for Specific Systems i TVA Medical Examiner's Guide, Volume I, VIII. Special Examinations for Specific Exposuree l ) TVA Helical Examiner's Guide, Volume I, II. Special Evaluations of ' Specific Health Conditions. TVA Medical Esaminer's Guide Volume II, Minimum Physical Requirements and Environmental Conditions for Selected TVA Job Titles l TVA Medical Raaminer's Guide. Documentation Files..VI. 2 Unescorted I Access to Nuclear Plants TVA Medical Examiner's Guide, Documentation Files VI. 3 Nuclear 1 Reactor Operator Licensure American National Standard N18.17-1973, " Industrial Security for Nuclear Power Plants" as amended, which includes American Nuclear Society ANS 3.3-1982, " Security for Nuclear Power Plants" n l Pete 1 of 3 6 w ___m_____-__-___

s ATTACHMENT C (Continued) American National Standard ANSI /ANS-3.4-1983, " Medical Certification and Monitoring of Personnel Requiring Operator Licenses for Nuclear Power Plants" NRC Regulatory Guide 1.134 " Medical Evaluation of Nuclear Power Plant Personnel Requiring Operator Licenses" i TVA Memorandum to Mark B. Whitaker from H. E. Lindler dated August 16, 1986, " Summary of Information Exchange Visits with Selected Southeastern Utilities" TVA's Occupational Health and Medical Services - A Historical i j Documentation. 1933-1984_ Tennessee Valley Authority, Division of Medical Services, Program i Outline, (MED SV 2/86) TVA Memorandum to "Those listed" from Frank D. Faires, dated November 20, 1981, " Falsification of Medical Record Information" TENNESSEE VALLEY AUTHORITY ACT TVA Division of Medical Services, Selected Clinical Services Report, September 30, 1985 through June 30, 1986 TVA Division of Medical Services, A. History of TVA Medical Examinations. B. TVA Requirements for Special Examinations. and C. Statutory Requirements for Examinations (March 5,1976) TVA Selected Activities Summary, Division of Medical Services, FY 1982 TVA Selected Activities Summary, Division of Medical Services, FY 1983 j i TVA Selected Activities Summaries, Division of Medical Services. Quarters ending March 31, 1979 through December 31, 1984 U.S. Department of Labor. Employment Standards Administration Office of Workers' Compensation Programs, Division of Federal Employees' Compensation, " Agency FECA Injury Reporting Time-Lag Analysis " FY 86 " Reducing Civilian Injury Claims, Six Successes in Meeting Presidential Goals," United States Army Safety Center Positive Case Manar.ement Handbook, Work Injury Compensation Services, Tennessee Valley Authority June 1986 Managing Injury Compensation Claims and Promoting Recovery and Return to Work; Summary of TVA's Injury Compensation Experience, January 1982 Background Paper Federal Employee's Compensation Experience. Tennessee Valley Authority, January 20, 1982 l Page 2 of 3 A____ _ _ _ _ _ _ _ __

t l f l ATTACHNENT C (Continued) I' TVA memorandum to W. F. Willis from Charles Bonine, Jr. dated I January 22, 1981, "First Quarterly Executive Summary Report on { Workers' Compensation" i ~ \\ TVA memorandum to John W. Thompson from Robert L. Craig, M.D., dated j June 18, 1986, with the subject, " Quarterly Executive Summary Report I on Workers' Compensation" l I, l EEY TOPICS REPORTS, Division of Medical Services, dated i August 14, 1980; December 19, 1980; January 15, 1982; June 23, 1982; 1 and July 20, 1982 TVA Medical Recorda (Individual Employees) 1 { TVA Compensation Records (Individual Employees) ( TVA Personnel History Records (Individual Employees) 1 i l l l l l j i l l l l l l l l l 1' 1 L l I Page 3 of 3 [.. l l L l l

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~<- U ATTACHMENT D List of Names and Job Title of Those Interviewed UA Robert L. Craig, M.D., Medical Director Frank D. Faires Medical Administrator Richard K. McGee, Ph.D., Chief, Health Counseling and Rehabilitation Branch Elmo E. Emily Program Nanager, Work Injury Compensation Services Murphy S. Watson, Supervisor, Workers' Compensation Assistance Unit Debbie Youngblood, Claims Officer, Workers' Compensation Assistance Unit Edmund S. Lane, M.D.. Chief Physician, Central Area Medical Services Georgene L. Johnson, R.N., Supervisor of Nursing Services, Central Area Medical Services Patricia A. Nabors,R.N., Supervisor of Nursing Services. Watts Bar Medical Office W1111am A. Miller, R.N.,' Occupational Nurse Practitioner, Watts Bar Health Station UTILITIES Duke Power Company, Dr. Peter Loper Carolina Power and Light Company, Julia Craft, R.N. Virginia Power Company, Dr. William S. Dingledine Alabama Power Company Tom Chapel OTHER FEDERAL AGENCIES Leven B. Gray, Manager, Nuclear Industrial and Fire Safety-National Aeronautics and Space Administration Bill Billingsley, Director Safety and Environmental Management Division-General Services Administration Carl Elchinger, Director, Occupational Health and Safety-Veteran's Administration Joseph M. Dalton, Jr., Safety Manager. Division of Safety Management-Department of the Interior Richard Bauer, Manager. Injury Compensation Branch-United States Postal Services 4 '}}