Dr. Paula Lantsberger's job is to keep other people safer at theirs.

Lantsberger is president and co-founder of Occupational Medical Associates, a specialized medical practice here that focuses on work-related injury care, pre-employment exams, and continual health monitoring of workers. The practice, located at 323 E. Second, employs 12 people, including three physicians, a nurse practitioner, three medical assistants, and five support staff members. The practice was founded by Lantsberger and Dr. Terrance Rempel, and its third physician, Dr. Royce Van Gerpen, joined the clinic in 1994.

The majority of its patients, says Lantsberger, work in labor-intensive jobs—from commercial drivers and railroad workers to miners and workers exposed to hazardous materials—but the practice also offers care for workers in other industries that are heavily regulated.

"There is a whole series of requirements from the federal government in order to be able to do certain jobs," she says. "Department of Transportation drivers, asbestos workers, and lead workers are some that have a lot of requirements."

The pre-placement exams Occupational Medicine Associates offers help an employer evaluate the health and medical history of a potential employee to ensure he or she meets the physical requirements of a job.

"We can tell an employer of any restrictions based on past injuries or medical conditions," she says.

The practice's continual health monitoring of workers generally is for clients whose industries require such monitoring, and can include toxicology evaluations of employees, including for drug and alcohol screenings, as well as tests for harmful chemicals a worker might have been exposed to on the job.

Lantsberger says that for some workers, state or federal guidelines dictate mandatory checkups to ensure their health isn't being compromised by their job. For instance, the Spokane Police Department's meth lab cleanup team receives exams annually, she says.

She says the practice recently evaluated a group of workers from Grand Coulee Dam, in central Washington, who are doing welding on turbines in the dam, a task that can create a harmful chemical that can cause skin ulcers.

About half of the practice's patients fall into its third area of focus: treating on-the-job injuries that may be incurred while they are working, Lantsberger says.

"We get a lot of patients with chronic back problems and chronic pain," she says. "And if they can't go back to their job because of an injury, we also help them find a new career and vocational counseling."

Most of Occupational Medical Associate's patients are referred to it through their employers, and Lantsberger says the practice works with roughly 1,000 such employers throughout the Inland Northwest.

"We have a lot of smaller companies," she says. "That's the nice part. We have really good relationships with the companies and know the jobs and what the employees have to do on the jobs, which makes a difference."

Lantsberger says that often when a worker is injured on the job, the practice's physicians can create guidelines for the patient and his or her employer that outline activities the patient can or can't perform once back on the job.

"Sometimes workers can go back and have a limited duty program per the doctor's recommendations, and then they don't lose wages," she says.

Injured employees who are unable to work and are on time-loss wages through the state Department of Labor & Industries (L&I) receive 60 percent of their normal pay, she says.

"Most people don't budget to live on 60 percent of their wages, so they struggle" when that happens, Lantsberger says, adding that most injured workers want to get back on the job as quickly as possible.

The practice's three physicians all are certified mentors through L&I's Center of Occupational Health & Education. The grant-funded program helps doctors and employers get injured workers back on the job as quickly as possible, Lantsberger says.

"If someone is off the job for 10 months or more, it lowers their chance of going back to work for the same employer by 90 percent," she says.

She says the poor economy has affected the way workers handle job-related injuries in some cases, but the practice hasn't seen an increase in false injury claims as a result of the economy.

In fact, she says she's noticed that injured workers sometimes continue working with an injury because they're afraid of being fired for reporting their condition or they think they can make their unemployment benefits last longer if they work with an injury until it's physically impossible to continue.

"This is hard for employers reeling under the bad economy," she says. "L&I costs also go up for them when this happens."

Lantsberger says she believes that less than 5 percent of all work-injury claimants are untruthful.

"Part of that is because it's a difficult situation to be in," she says. "If you only get 60 percent of your wages, most people don't want to do that. They want to get better and back to work again."

When a worker is injured on the job, L&I pays for the entirety of their care, including doctor visits, medication, physical therapy, and surgery, Lantsberger says.

Other work the practice does, including pre-placement exams and mandatory checkups, are paid directly by the employer.

Lantsberger says that to treat employees in so many different industries with varying rules and regulations for health and safety, it's critical for her team to be up to date on state and federal laws.

"We have to keep up with so many changing regulations, so we're always doing continuing education to keep up with the rules," she says.

One of the practice's fastest growing areas has been its drug screening program, Lantsberger says, and its three doctors are certified medical review officers, which means they are able to interpret drug screens. Occupational Medical Associates does drug screening for about 1,500 companies, says Jenni Carr, the practice's assistant medical review officer.

As with mandatory health screenings, many companies also require random drug testing of employees.

"Any company should require drug testing," Carr asserts. "Some are mandated, but companies that aren't should be, such as jobs associated with patient care, machinery, and that are safety sensitive."

She says that on average, she sees between five and 10 positive drug screens a day, and that many are with pre-employment tests. Other times, an employer that suspects one of its workers might be using drugs will require all of its workers to be tested, while some industries require random screenings.

Carr says the most common drug she sees being used by workers is marijuana, followed by methamphetamines and cocaine. Prescription drug abuse is another area the tests can screen for, based on the patient's known prescriptions.

Typically, the practice will screen about 30 people a day, but during some seasons it could be closer to 100 people a day, she says.

Lantsberger says, "When I started, I was astonished at the number of drugs coming through on positive screens and the excuses that people gave.

"When I once asked a patient who had a positive screening for meth about her other medications, she said she'd never used meth, but that it was cocaine she'd been on."

The practice also offers breath alcohol tests.

"Every once in awhile people come into work looking like they can't perform, so the employer sends them over and they get screened," she says.