This paper will consider medical surveillance in the context of the Occupational Safety and Health Act of 1970. The Occupational Safety and Health Administration (OSHA) has issued (after rule making) health standards covering approximately 24 toxic substances, and all these standards have included medical surveillance programs. OSHA is not only empowered but compelled by law to require medical surveillance programs for exposed employees. At the same time, a number of major legal/policy issues relating to medical surveillance have been raised at the standards rule-making stage and litigated in court. Among the more significant of these are access to medical records, selection of physician, and medical removals. Many of these issues were involved in OSHA's Lead Standard, issued in 1978 and affirmed in relevant part by the Court of Appeals for the District of Columbia in