[Congressional Record Volume 147, Number 29 (Wednesday, March 7, 2001)]
[House]
[Pages H718-H720]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  C-SPAN, ERGONOMICS, THE PRESIDENT'S TAX CUT AND PATIENT PROTECTION 
                              LEGISLATION

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2001, the gentleman from Iowa (Mr. Ganske) is recognized for 
60 minutes as the designee of the majority leader.
  Mr. GANSKE. Mr. Speaker, this morning started out with a breakfast 
that I and other Members and past Members of Congress had with Brian 
Lamb, who is the head of C-SPAN, the chief executive officer of C-SPAN. 
I must give a lot of credit to C-SPAN, because it is bringing democracy 
into millions and millions of homes every day and has opened up the 
political process more than ever before. Sometimes I will give a 
special order and I will invariably hear from home from some of my 
constituents and very, very frequently I will hear from my colleagues 
here in Congress on a comment on what I spoke about. I know that other 
Members who take part in special orders find the same thing. A major 
reason for that is because of the coverage by C-SPAN, a real service. 
Mr. Lamb is a gentleman and I think a patriot for selflessly giving up 
of his time and tremendous work and energy to provide a service for 
citizens around the country and a service that also helps us do our 
business here. Because there will be innumerable nights when I will be 
working in my office and there will be coverage here on the floor or 
during the daytime when we are all tied up in committee meetings and 
other things, and we get to follow what is going on on the floor via 
the coverage from C-SPAN.
  I think tonight is a good example of the type of diverse comments 
that are covered, especially after regular order and during what is 
called special orders, about the only time that Congressmen and 
Congresswomen have to speak at any length of time is during this time.
  Mr. Speaker, we have 435 Members of the House. We can fill every seat 
in this room. And because there are so many of us, the rules of the 
House make it so that when we debate an important issue, there is a 
limited amount of time. We do not have the luxury of only having 100 
members like they do in the Senate where the Senators can speak for 
extended periods of time and develop completely ideas. And so what 
frequently happens is that during a debate on an issue like today when 
we spoke about workplace regulations on ergonomics, we will have a set 
period of time for debate, it will be divided between both sides, the 
Republicans and the Democrats, and then, because so many Members want 
to speak on an issue, like will happen tomorrow when we debate the tax 
cut, there is

[[Page H719]]

 only a very small amount of time that is allotted to each Member. And 
so, unfortunately, frequently the volume is turned up and the thought 
does not get very well developed, and we end up sometimes, I am afraid, 
with some shouting on the floor and more partisanship than we need to 
see. And basically we are talking from soundbites. And so I very much 
appreciate the chance that we have on evenings like this to address 
some issues in a little more depth, and I think it is really, really 
important that we maintain the opportunity to do that.
  I have learned a lot tonight in sitting on the floor and listening to 
fellow Members. We have just had the gentlewoman from Texas (Ms. 
Jackson-Lee), the gentleman from Alabama (Mr. Hilliard) and the 
gentleman from Georgia (Mr. Lewis) talk about an event that happened 36 
years ago. Unfortunately probably most Americans do not know what 
happened at the Edmund Pettus Bridge, but it was really, really 
important to a lot of people after it happened.
  Mr. Speaker, it will not be long before you and I are not around, or 
any of us are around, and hardly anyone will remember any of us very 
long. But there is a saying that is engraved by Robert Kennedy's 
gravestone that I think is appropriate, and it is why we all work in 
public service and why at home we work for our families. It is not that 
there is any expectation that we are going to be famous or that we are 
going to be remembered for any period of time, it is just that if you 
toss that small pebble into the ocean, you will make a little splash, 
and it will create a little wave, and if enough other people do that, 
you will create a current, and a current adds to a current and 
collectively you can make a difference just like those men and women 
did 36 years ago that resulted in millions and millions of people 
getting the right to vote. I really appreciate the comments tonight 
that we have had from our colleagues.
  We do not always agree. I do not agree that in Florida there was any 
evidence that any fraud took place. And so I would take issue with 
statements that were made tonight in that regard. But my plea to Mr. 
Lamb is that we are allowed to continue to have special orders 
broadcast. I think it is important. We can communicate with our 
colleagues back in the office buildings after hours, or sometimes even 
in their apartments here on Capitol Hill. We can communicate with 
constituents. And it gives us our only chance here in the House to talk 
about an issue in some depth without having to shout soundbites.
  So tonight, Mr. Speaker, I want to talk about a couple of issues. 
Earlier today, the House dealt with the proposed new workplace 
regulations on repetitive-type injuries, or the ergonomics rule. When I 
was on the floor earlier today and wanted to speak on this, I was given 
1\1/2\ minutes to talk on this complex issue. So I looked at my speech 
and I tried to pare it down and sure enough I ran out of time right at 
the end. So I am going to speak a little bit about that, because it is 
an awfully important issue, to workers, to employers, and really to our 
economy.
  Tomorrow we are going to be debating a tax cut bill. So today I went 
to the floor, here on the floor, I ran into the chairman of the 
Committee on Ways and Means, and I asked the gentleman from California 
(Mr. Thomas) if I could have some time to speak on the tax cut. Well, 
he thought that maybe I could have a minute or two, but he had an awful 
lot of people on his own committee who wanted to speak. So tonight I am 
going to develop a little bit further my thoughts on a tax cut.
  We have before us in Congress a very important issue on patient 
protection, and how people are treated by their HMOs. Goodness, Mr. 
Speaker, I can remember about 3 years ago now this coming to the floor 
and we had 1 hour of debate on each side, which meant that everyone who 
wanted to speak got about 1 minute or 2 minutes, so tonight I am going 
to spend a little bit of my time on that, too.
  Mr. Speaker, I applaud yesterday's vote in the Senate on the proposed 
ergonomics rule in which 56 Senators to 44 voted that the proposed 
regulations were inappropriate and that we should do them again.

                              {time}  2100

  I applaud the House of Representatives in taking a similar position 
today.
  Mr. Speaker, prior to coming to Congress, I was a reconstructive 
surgeon who treated a large number of patients with upper extremity 
musculoskeletal disorders, some of which were disease processes like 
carpal tunnel, cubital tunnel, tendonitis.
  Mr. Speaker, I am not a spokesperson for these organizations; but I 
am the only Member of Congress who is a member of both national hand 
surgery societies, the American Society for Surgery of the Hand and the 
American Association of Hand Surgery; the only Member of Congress who 
has actually treated patients with ergonomic diseases. Like hand 
surgeons around the country, I share OSHA's concerns about the health 
and safety of workers and I am dedicated, as all hand surgeons are, to 
helping prevent and reduce workplace injuries.
  Repetitive stress injury is poorly understood. The diagnosis is made 
far too commonly and the implications of that diagnosis are far-
reaching for patients, employers, employees, and third party payers. 
Like OSHA, I and thousands of other hand surgeons recognize the need to 
pay close attention to musculoskeletal aches and pains and to 
appropriately diagnosis and treat musculoskeletal disease in a timely 
fashion. However, I believe that OSHA's new ergonomic rules are not 
founded on, ``a substantial body of evidence.'' I agree with the 
National Research Council that more study is important.
  Mr. Speaker, we need a better understanding of the mechanisms that 
underlie the relationships between causal factors and outcomes. We need 
to clarify the relationships between symptoms, injury, injury reporting 
and disability on the one hand and work and individual and social 
factors on the other.
  We need more information on the relationship between the degree of 
different mechanical stressors and the biological response in order to 
understand what is known as a dose response relationship, and then to 
define risk.
  Mr. Speaker, we need to clarify the clinical course of 
musculoskeletal disorders.
  Now, as someone who has treated a lot of patients with this problem, 
I can say that it is not always easy to distinguish various aches and 
pains from musculoskeletal disorders. Unfortunately, Mr. Speaker, the 
older we get the more often we all end up with aches and pains, but we 
do not all have ergonomics, ergonomic-type diseases or disorders.
  It is paramount, Mr. Speaker, to the patient's welfare and future in 
the workforce to make the correct diagnosis. If a patient is told that 
he or she has a musculoskeletal disease, quote/unquote, it can actually 
encourage a disease mentality where one may not have existed before.
  This regulation that the House tonight just rejected, in my opinion, 
could have actually harmed patients. For instance, OSHA describes 
``observable'' physical signs that would constitute, quote, ``a 
recordable musculoskeletal disease,'' unquote, that would have to be 
reported by the employer.
  Now, some of those signs that OSHA talks about that the employer is 
supposed to look for are things like decreased grip strength or 
decreased range of motion. Mr. Speaker, all hand surgeons know that 
those types of tests can be very subjective. How does one know how hard 
somebody is trying to grip? How does one know if they are cooperating 
fully with a full range of motion? This is something, that according to 
these regulations, is supposed to be done by the employer.
  I am troubled that in those regulations the truly objective type of 
findings, the things that can be reproduced without a patient's 
subjective input, things like atrophy, reflex changes, 
electrodiagnostic abnormalities and certain imaging findings, these 
were not the things that were required by the employers to report. The 
MSD symptoms in the rule do not require objective verification in order 
to be recordable. So, in my opinion, that places much too much 
responsibility on both the worker and on the employer to make a correct 
diagnosis.
  This gets to be a problem because of this: Mr. Speaker, we know that 
in the

[[Page H720]]

general population about 2 to 10 percent of the public can have bodily 
complaints as a manifestation of psychosocial disorders and, Mr. 
Speaker, in my opinion it is more common to see that in a group of 
patients when one is dealing with work-related musculoskeletal 
disorders, and especially when one is dealing with worker's 
compensation.
  Dealing with these patients in order to help them continue to be 
productive members of society, for their own welfare, is a real art. It 
requires an optimistic approach. It requires reassurance. One needs to 
be very careful that they do not set in motion expectations by the 
patient that they may not be able to get back to work.
  I am afraid that that proposed rule, which fortunately the House 
tonight decided to send back to the drawing board, would have instantly 
made millions of individuals eligible for extensive treatment with up 
to 6 months' paid time off, and I will guarantee, Mr. Speaker, that 
that regulation would not have helped those individuals in the long 
run.
  So let me repeat, I share OSHA's concern about health and safety, and 
now that this rule is off the table here is what I think we should do: 
We should support a national research agenda on work-related injuries, 
especially repetitive stress-type injuries. We should collect the 
necessary scientific data. We should then incrementally implement 
standards. We should test-control on-the-job pilot programs of the 
proposed new rule's various parts, instead of just jumping into a stack 
of regulations that high.
  Mr. Speaker, we need to be very careful in the development of the 
diagnostic criteria and the clinical guidelines for employers, workers 
and health care professionals in the evaluation and management of 
musculoskeletal diseases in the workplace.
  So because of the action both the House and the Senate have taken and 
on the assumption that President Bush will sign what we did today, we 
are going back to the drawing board. We have had assurances from the 
new Secretary of Labor that she wants to work on this. I think it is 
very important that when new regulations come back to us that they are 
done right.

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