California Medical Supervision Program

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The California Medical Supervision Program is designed to protect agricultural workers who regularly handle Type I and II organophosphate (OP) and carbamate (CB) pesticides. It requires employers to contract with a medical supervisor to monitor the blood cholinesterase levels of their workers. Cholinesterase is critical for the normal function of the nervous system. Overexposure to OP and CB pesticides can lead to a depression in cholinesterase activity levels, which can lead to various adverse health effects. The California Department of Pesticide Regulation is responsible for the overall administration of the Program. The Office of Environmental Health Hazard Assessment is responsible for outreach and education of medical supervisors, and the California Department of Public Health is responsible for approving laboratories performing cholinesterase analysis.

Documents

• DPR and OEHHA released the 2021 Update Report on the Effectiveness of the California Medical Supervision Program and the Utility of Laboratory-based Reporting of Cholinesterase Testing for Illness Surveillance and Prevention, PDF (April 29, 2022)
• DPR Legislative Reports, Mandated Reports - Regulatory

Information for Employers

• Regulation requiring medical supervision for certain pesticide workers (Title 3, California Code of Regulations, section 6728)
• Employer Responsibilities Under the California Medical Supervision Program, PDF (E HS-1760, 1/18)
• List of Registered Medical Supervisors

Information for Physicians

• Guidelines for physicians, PDF who supervise workers exposed to cholinesterase- inhibiting pesticides
• Medical Supervision of Pesticide Workers One-Page Summary, PDF
• Comparing Symptoms of Heat Stress and Pesticide Poisoning (organophosphate/carbamate), PDF - Maryland Cooperative Extension publication
• USEPA Handbook Recognition and Management of Pesticide Poisonings
  • Chapter 5: Organophosphate Insecticide, PDF
  • Chapter 6: N-Methyl Carbamate Insecticide, PDF
• Laboratories approved for cholinesterase testing for occupational health surveillance
  • Regulation requiring laboratories approved for occupational health surveillance cholinesterase testing to report results to DPR, PDF

Other Resources

• California Medical Supervision Program - OEHHA
• Washington Cholinesterase Monitoring Program

For content questions, contact:
1001 I Street, P.O. Box 4015
Sacramento, CA 95812-4015
Phone: (916) 445-4222
E-mail: pisp@cdpr.ca.gov