At large corporations with thousands of employees, health issues surface on a daily basis. When is an injured factory worker ready to return to his job? What should be done for an employee exposed to asbestos or other toxic materials? How many weeks are allowable for paternity leave? What is the best way to incorporate an employee wellness program?

The Medical Advisorship, an innovative program sponsored by the Occupational Health Service Institute (OHSI), part of the Great Lakes Center for Occupational and Environmental Safety and Health, provides the services of board-certified occupational medicine faculty members to local corporations that need assistance in meeting these and other health care challenges. Currently, advisors work with AT&T, Rand McNally & Co., Quaker Oats Company, and Federal Occupational Health, provider of health and safety services for federal workers.

"Corporations used to have full-time medical directors, but in the past several years they have started outsourcing many of their occupational health programs," says OHSI director Daniel Hryhorczuk, MD, MPH._ "Now they use our faculty on a part-time basis for services including disability evaluations,_advice on occupational health care policy issues, and help in complying with regulations related to occupational safety and health."

OHSI was established in 1994 by Chancellor David Broski to fulfill the service mission of the Great Lakes Center for Occupational and Environmental Safety and Health in a way consistent with President James Stukel’s Great Cities Initiative. In addition to its teaching and research mission, the Great Lakes Center exists to "improve, promote, and maintain the health of workers and communities...by providing technical assistance and consultation to labor, management, health care institutions, government agencies, and local communities."

Corporations that contract with OHSI benefit from across-the-board expertise. While direct contact is with a single medical advisor, the institute’s interdisciplinary faculty and the resources of the Great Lakes Center as a whole are brought to bear on their concerns. Corporations also can rest assured that, when necessary, medical advisors will turn to national experts on a range of subjects including workplace violence.

"The medical advisors are very well informed about occupational health and, because they are in an academic setting, they keep us up to date," says Jean Eichenberger, regional occupational health services manager for AT&T in Chicago. "They also can consult with university experts on industrial hygiene, public safety, and other issues to help resolve problems in the workplace."

Medical advisors handle both daily health care concerns and those of an emergency nature. Patricia Kelleher, MD, MPH, and Denise Costelloe, RN, manage the Health Services Clinic at Rand McNally & Co. in Skokie. The two offer flu vaccines in the fall, manage the employee fitness center, sponsor twice-yearly blood drives,_perform ergonomic reviews, and periodically check employees who are known to have high blood pressure. Kelleher visits Rand once a week; Costelloe is on hand three days a week.

"Kelleher and Costelloe issue a wellness newsletter once a month and provide brown bag lunch lectures," says Steven Kull, director of compensation and benefits at Rand McNally. "They also sponsored a very successful health fair with twenty-six vendors whose booths offered cholesterol screenings, organ bank donor registration, pharmaceutical information, weight management suggestions, and other health tips. About 250 of our 400 employees participated."

Kelleher and Costelloe also provide case management for Rand employees on leaves of absence. Since the program began, the company has seen a 25 percent decrease in its leave-of-absence caseload.

David Marder, MD, MPH, medical advisor at Quaker, is available for consultations and case planning for the company’s twenty U.S. locations. He reviews the executive physical program and spends considerable time on disability evaluations.

"We evaluate employees on long- or short-term disability to determine if it is appropriate for them to have their disability renewed, remain on disability, or return to work," Marder says.

Sue Gieske, RN, disability coordinator for Quaker, notes that Marder’s work has contributed to improving the company’s bottom line. "Our cases are managed more effectively and more efficiently," she says. "He is very helpful in return-to-work issues, returning people to work more carefully, and many times at an earlier date. That increases productivity and decreases disability dollars."

Institute medical advisors also problem-solve for the U.S. government. In 1997, the institute aided the Environmental Protection Agency (EPA) in a Chicago-area pesticide clean-up project aimed at the chemical methyl parathion which had been used inadvertently in several hundred homes.

Hryhorczuk chaired an expert panel, guiding the project for the EPA and the Agency for Toxic Substances and Disease Registry. Kelleher and Katherine Duvall, MD,_MPH, Federal Occupational Health medical advisor, handled medical surveillance for workers involved in the clean up. Physicians at Cook County Hospital’s toxicology and occupational medicine programs organized care for residents of the homes and triaged suspected clinical cases to the hospital. Finally, UIC provided medical surveillance services for many of the private companies that subcontracted to the EPA on the clean up.

Overall, the project exemplified the Occupational Health Service Institute’s ability to provide a combined academic and hands-on approach to solving public health problems in both the public and private arenas.

Contributed by Janice Rosenberg