June 2005 Archives

June 30, 2005


Heat kills. This is a fact that was underscored publicly last week with the release of autopsy results for Scott Laio, a 20-year-old Boston College student who collapsed and died after rowing in the Dad Vail Regatta in May. The Philadelphia Medical Examiner's Office attributed the cause of death to a fluid and electrolyte imbalance and heat stress. Physical exertion causes the body to lose fluid through sweat, and it's essential that fluid be replaced at regular intervals. The U.S. Army - an entity that has some amassed some deep knowledge in the business of physical exertion in conditions of extreme heat - recommends minimum and maximum fluid replacement guidelines(PDF) for varying levels of exertion, as well as other heat injury prevention resources.

Heightened risk for some workers
Here in New England, we've been in the throes of an oppressive heat wave for the last week that has left me sluggish, and wistfully hoping for a late-afternoon thundershower at the close of each day. But as I slip from air-conditioned office to air-conditioned car, I think of the workers who have little relief from the heat. Outdoor workers such as agricultural workers, landscapers, lifeguards, construction crews, and road workers are particularly at risk for heat-related illnesses. And pity the outdoor workers whose jobs call for protective equipment, like firefighters and pesticide workers - the risks are that much greater because heavy gear can interfere with sweating, which is the body's natural cooling mechanism.

ErgoWeb has a report on new heat stress resources for firefighters and other workers who work in environments that put them at heightened risk for heat disorders. The article reports on research conducted by Tom McLellan and Glen Selkirk:

"Working with Toronto Firefighters in ambient summer conditions, the researchers compared active and passive cooling strategies in combination with different levels of hydration. They found that the active approach -- a combination of fluid replacement and misters or the submersion of the forearm and hand in cool water -- effectively brings down the body's core temperature. The study found that this combination was twice as effective as the passive approach -- hydration and the removal of the protective clothing only.

This research offers corroboration to a practice that many of us may have intuitively known in our day-today lives, but that may nor be widely employed in work settings.

Preventing heat-related illnesses
Of course, workers don't need to work outdoors, in heavy clothing, or in extreme conditions to be at risk. A sudden or prolonged heat wave can put many other workers at risk. And a variety of individual factors such as age, weight, physical conditioning, medication, alcohol, caffeine, and salt can heighten the risk.

Employers would do well to review OSHA's Heat Stress Guide and conduct self-assessments about their own seasonal readiness for worker heat stress prevention. The article Beating the Heat by Donna Miles in Occupational Hazards offers some good advice. Here are some tips from the article:

  • Encourage workers to drink plenty of water - about a cup of water every 15 to 20 minutes, even if they are not thirsty - and avoid alcohol, coffee, tea and caffeinated soft drinks that dehydrate the body.
  • Help workers adjust to the heat by assigning a lighter workload and longer rest periods for the first five to seven days of intense heat. This process needs to start all over again when a worker returns from vacation or absence from the job.
  • Encourage workers to wear lightweight, light-colored, loose-fitting clothing. Workers should change their clothes if they get completely saturated.
  • Use general ventilation and spot cooling at points of high heat production. Good airflow increases evaporation and cooling of the skin.
  • Train first-aid workers to recognize and treat the signs of heat stress and be sure all workers know who has been trained to detect early signs of heat-related illness. Permit workers to interrupt their work if they become extremely uncomfortable.
  • Consider a worker's physical condition when determining fitness to work in hot environments. Obesity, lack of conditioning, pregnancy and inadequate rest can increase susceptibility to heat stress.
  • Alternate work and rest periods, with rest periods in a cooler area. Shorter, more frequent work-rest cycles are best. Schedule heavy work for cooler times of the day and use appropriate protective clothing.
  • Monitor temperatures, humidity and workers' responses to heat at least hourly.

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June 28, 2005


The Insider has frequently explored the ramifications of getting work done through employees (who are protected by workers comp) and through independent contractors (who have no such protection). The practice of using independent contractors can save a lot of money in workers comp premiums, especially when your employees perform the more expensive classes of work such as in those in the building trades. But sometimes the strategy backfires.

Fifteen people were killed in a March 23 blast at a BP oil refinery in Texas. More than 170 were injured, dozens of them seriously, in what was the worst United States refinery accident in recent memory. Anne Belli of the Houston Chronicle has done a terrific job of reporting on this tragedy. Although performing regular work at the site, most of the injured were not BP employees; they were independent contractors. While the strategy of staffing the plant with contractors surely made business sense at the time, in retrospect, from a financial perspective, it has turned into a real disaster.

Exclusive Remedy
Had the killed and injured workers been employees of BP, workers comp would be the exclusive remedy. Dependents of the deceased workers would be entitled to death and dependency benefits; the injured workers would collect indemnity benefits and all their medical bills would be paid. Even though there are some indications that the company failed to follow through on safety issues, even though the company may have been in some respects negligent in their operation of the facility, employees would be limited to the statutory benefits under workers comp. Employees cannot sue their employers for work related injuries. Under the usual workers comp benefit structure, the fatalities would generate claims valued at less than $1 million; for the seriously burned, who face years and years of treatments, you might see reserves in the $3 to 5 million range. It's hard to believe, but these amounts are far less than what BP is now facing.

Contractors can Sue
Because many of the deceased and injured were not BP employees, they are suing BP as a third party and collecting not just indemnity and medical benefits, but also tort liabilities for pain and suffering, loss of consortium and so on. The liabilities for BP in this situation are formidable. In what can only be regarded as a remarkably rapid process, BP has already agreed to settle with several of the families of the contractors and is in the process of settling with dozens more. And here's the financial rub: these settlements are running in the tens of millions for each family. The article quotes a number of the plaintiff attorneys involved, who seem stunned that BP has accepted liability so readily and is offering such generous settlements to resolve the cases.

In the days following the explosion, BP seemed inclined to blame the workers for not following procedures. If they really thought that this was a viable position, they would probably not be so interested in offering generous settlements. The post accident investigation brought in federal investigators with the U.S. Chemical Safety and Hazard Investigation Board. The investigators have stated that BP management may well have dropped the safety ball. Had BP equipped the blowdown system with a flare, as is standard in the industry, the hydrocarbons might have been burned safely away and the accident might have been prevented. In addition, OSHA warned BP 13 years ago that the lack of flares on a vent stack at the refinery was hazardous to the environment and to workers. I think BP's lawyers took a careful look at the history and threw in the proverbial towel.

Bottom Lines and Human Lives
This is nothing less than a tragic tale of unnecessary death, suffering and loss. I suppose it's better for the families that their loved ones were not BP employees -- the proposed settlements will support the survivors far better than comp benefits would have. But the real question is not really one of business strategies and honing the bottom line. It's how BP lost sight of the real dangers in their workplace and missed numerous opportunities to fix them. How ironic is it that the most cost effective strategy for BP had nothing at all to do with employees versus contractors? No, it was simply a matter of listening to OSHA back in 1992 and making some adjustments in the plant infrastructure. A safer workplace would have been a lot less expensive to operate than what BP has now -- a fire ravaged plant and a tragically decimated crew .

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June 28, 2005


Quick - name the three leading industries with the overall greatest numbers of injuries and illnesses.

I've run this little pop quiz on people who work in the industry and those who don't, and it's rare that people get the right answers. According to Bureau of Labor Statistics, the dubious *winners* in the win, place, and show categories are laborers and material movers; heavy and tractor-trailer truck drivers; and nursing aides, orderlies, and attendants. (source)

For many people, this information is something like a game my nieces used to play called "one of these things is not like the other." Many are startled to learn that our nation's healthcare workers are right up there in the ranks of the nation's most hazardous professions. The reason is largely due to patient handling that takes a heavy toll in back and neck injuries. An article in ErgoWeb describes some of the hazards for nursing home staff.

"In "Ergonomics: Guidelines for Nursing Homes," OSHA identifies work-related musculoskeletal disorders (MSDs) that include low back pain, sciatica, rotator cuff injuries, epicondylitis and carpal tunnel syndrome. It isn't difficult to pinpoint why MSDs are such a problem. Nursing home employees care for residents who are disabled by frailty, stroke, fractures, Alzheimer's disease and other conditions. The work involves heavy lifting, often in confined and awkward spaces.

Some good news from Texas
From Jordan Barab's Confined Space, we learn that Texas has taken legislative steps to protect healthcare worker safety. The state is the first to enact legislation (TX SB 1525) requiring hospitals and nursing homes to implement a safe patient handling and movement program. The legislation takes effect on January 1, 2006. In his post, Jordan notes:

Most significantly, the law requires the plan to include "procedures for nurses to refuse to perform or be involved in patient handling or movement that the nurse believes in good faith will expose a patient or a nurse to an unacceptable risk of injury."

This is good news for healthcare workers and hopefully other states will follow suit since OSHA has issued only ergonomic guidelines which, although good for what they are, many feel are meaningless in terms of affording workers any protection.

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June 27, 2005


David Montgomery, a staff writer for the Washington Post, has written a moving and intimate article (registration required) about John Keitz, who weighs 625 pounds (down from his maximum weight of 781 pounds). The article is accompanied by a remarkable set of photographs, which you should be able to link to at the article. Keitz is so heavy his legs will not support his weight. The last time he stood on his feet was Aug. 1, 1998. That night he was making macaroni and cheese for his wife, Gina. He boiled and drained the noodles. Right after he cut in the Velveeta (nutritionists take note), he went down -- and he has been bedridden ever since. Keitz is 39 years old. This article presents Keitz as a man of Falstaffian dimensions, who regales the reporter with his exploits as a youth and dreams of the day when he can sit up and even stand up on his own.

Morbid Obesity Personified
Keitz has to lie on his front, because if he were to lie on his back, rolls of flesh would press on his windpipe and suffocate him. His head never touches sheet or pillow. At night, his left cheek nestles upon a soft white pile of shoulder and breast meat.

Every time Keitz must be moved -- usually to the hospital to treat his asthma -- a major public drama ensues. One time, firefighters removed two windows from his second-story apartment and extracted him with a lift truck. More recently, firefighters used a whale sling from the National Aquarium in Baltimore to haul him out of his house in Dundalk. They put him on a flatbed truck. His ordeal was rehashed on late-night television and morning radio.

Obesity as Illness
At 26, Keitz got the first dramatic warning that his weight was barreling out of control. On the job at a bowling alley, his knees gave out. Doctors diagnosed severe arthritis. He stopped working regularly and began receiving disability checks. I think we can assume that the disability payments were under SSDI and not workers comp.

Montgomery writes that many scientists, doctors and health insurance executives are coming around to the conviction that obesity is a disease. But it is a disease with personal responsibility attached. Advocates for obese people say health care is full of conditions that involve personal choice: smoking; alcoholism; gum disease brought on by poor dental hygiene; skin cancer following too much tanning. Yet obesity is unique in how much blame is placed on the victims themselves. "Once you take off this moral interpretation, it is a dysfunction of the body and an abnormal physiological state," says Morgan Downey, executive director of the American Obesity Association in Washington.

Workers Comp Risks
I would direct you to the 6th image in the gallery of photos that accompanies the article. (It is sometimes difficult to access Washington Post articles, so I will describe the scene in detail.) Six men from East Coast Ambulance surround Keitz. They have placed a yellow rubber tarp under him. On the count of three, they all lift. You can see the strain on the face of one of the men near to the camera -- the faces of the others are obscured in the dim light of the dingy apartment. The men have only the yellow tarp to hold -- there are no handles, so the lift places tremendous pressure on their forearms, fingers and wrists. Four of the men are clustered around Keitz's formidable upper body, so only two are available to lift his lower body. Theoretically, it's a 105 pound lift for each man. However, Keitz's great bulk is prone to shifting, so the weight itself may change as they head for the ambulance. Indeed, you can tell from the photo that some of the men bear more weight than others (at least one appears to be "dogging" it). Ergonomically, the lift is far from ideal. Beyond that, there is clutter on the floor -- tripping hazards for the men as they begin to move Keitz toward the door. There is no stretcher or gurney in the photo -- it appears that they are going to carry him out of the house to the waiting ambulance.

The doorway is of average width. How will the men get through it, when Keitz's bulk alone will barely fit through? The men at his head will have to squeeze ahead, while trying to keep Keitz from slipping out of the sling. We are left with no answers, as this is the only photo of this particular move. Given the absence of additional details in what is a very comprehensive article, perhaps we can assume that the lift was performed without any problems. No workers comp claims this time. (One hospital client of ours had two serious back injuries in the single lift from an ambulance of a similarly sized person.)

Heavy Issues
Obesity is surely a personal crisis for those who suffer from it, as well as for those who love them. It presents challenges to employers. It is also a crisis for the insurance industry -- to pay or not to pay for stomach stapling, that is the question -- see this Los Angeles Times article. On the front lines, it's a huge challenge for health care workers who are called upon to move morbidly obese individuals under very difficult conditions. In the working world, it's not always possible to perform the work as outlined in the ergonomic textbooks. All too often the workers -- and their employers -- are left to bear the consequences.

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June 23, 2005


When we first started Workers Comp Insider, related weblogs were far and few between. We are pleased to see new entrants are joining the so-called blogisphere almost daily now - be sure to visit our expanding blogroll to check out blogs that we find of interest. Here are a few that we've added today:

We're pleased to see that our friends at the very useful workerscompensation.com have added a weblog to the many services they offer - visit them at Comp Blog. Today, they feature a radio interview with an attorney on the workers comp changes in Oklahoma. We wish them the best - they have been kind enough to feature our posts in their new daily blog center.

Specialty Insurance Blog by Bob Sargent, President of Tennant Risk Services, is aimed at insurance wonks, particularly those with an interest in specialty lines. Lately he's made a few posts on contingent commissions and the need for transparency, a topic that commands attention for many of us.

MSSP Nexus is a lively blog by Rita Schwab with news and commentary aimed at medical professionals and those who work in healthcare management, medical staff administration, quality, accreditation, law, and provider credentialing. We found the link at Joe Paduda's blogroll a few weeks back, and have been keeping an eye on it since. Read her recent post on a federal court decision that held that a Louisiana hospital had a duty to disclose information about their medical staff members to a Washington hospital to protect future patients.

The Disabled Worker Law Blog is a substantive blog by the staff at Turley, Redmond & Rosasco. We have several employer-leaning law blogs in our sidebar, so we thought that this would be a good addition to offer another perspective. Of particular interest is this post on how the proposal to raise the age for Social Security benefits to 69 is likely to put more workers on disability. We recently posted about older workers - such a change could add a further wrinkle to what is an emerging risk.

Business guru and author Tom Peters has an interesting weblog as the main page of his website. Tom and his colleagues at the Tom Peters Company all contribute posts and can be counted on for interesting and informed business commentary. I like the fact that "work that makes a difference" is among his own company's values. Call me a little bit corny, but I like to think of that as a mission for all of us employed in workers compensation: making a difference for employers and employees alike. Social insurance is not really about pushing around pieces of paper - it's about people.

And lastly, here are a few new tools we've found useful:
Abbreviations and Acronyms of the U.S. Government - a handy little reference guide.

HRTools.com - lots of good tools and resources here on many aspects of human resources. Some require paid registration, but many are free.

National Guideline Clearinghouse - a public resource for evidence-based clinical practice guidelines. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. NGC was originally created by AHRQ in partnership with the American Medical Association and the American Association of Health Plans (now America's Health Insurance Plans [AHIP]).

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June 22, 2005


The Insider has occasionally wondered about the thought process that leads a doctor to prescribe a specific medication for a particular injury. We are intrigued by the continued popularity of Oxycontin, which, even with its track record of abuse and addiction, is still the one of the most popular pain killing drugs in the workers compensation system. We wonder how drug companies influence the decision-making of doctors. How do they get inside the doc's head?

Today we explore an easier question to answer: How do drug companies get into the heads of consumers? An article in today's Los Angeles Times (registration required) explores the impact of direct advertising on consumers and discusses a growing backlash against these drug ads.

New Speech
Drug advertising to the general public is a $4.5 billion dollar industry -- and a fairly new one at that. The FDA has permitted these direct appeals only since 1977. It is interesting to note that the U.S. is the only country that permits pharmacy companies to bypass doctors and go directly to consumers in their search for increased market shares. So every day we are bombarded with images in the media: wonder drugs that will lower cholesterol, control diabetes, improve sex lives, grow hair, cure flatulance, conquer depression and presumably, enable us to live forever.

For whatever reason, drug ads appear to work. A Kaiser Foundation survey in 2001 found that 30% of Americans had spoken to a physician about a specific medication they had seen advertised. Of these, 44% reported that they came away from the doctor with the prescription they asked about. These numbers have probably gone up since the survey was completed. This might be good -- assuming that the ads increased consumer awareness of real medical problems. Or it might be bad -- assuming that harried doctors wrote the scripts to satisfy their customers.

Doctors and public health officials are increasingly wary of the impact of advertising on American medicine. They fear that the advertising leads to the widespread use of costly brand-name medications, in many cases by people who don't really need them, or who should not take them, or people who might achieve the same result with more established and less expensive treatment.

The Vioxx Story
Vioxx, developed as an arthritis drug, was touted through a $300 million ad campaign between 2000 and 2001. It is probably not a coincidence that in 2002 it was the third most prescribed drug in the workers compensation system -- prescribed, I would note, not for its original use in arthritis (which is not work related), but for pain. In September 2004 Vioxx was removed from the market due to "increased risk of cardiovascular events" -- industry speak for "heart attack."

After eight years of increasingly aggressive advertising, even the pharmacy industry is having second thoughts. Or it might be more accurate to say, the industry, anticipating a backlash from doctors and regulators, is taking steps to voluntarily limit advertising. There is no way they will agree to a total ban -- once the door was opened to advertising, it will prove impossible to shut it completely. If you are interested in the industry's own perspective, one of their lobbyists resides here. It's a matter of "free speech" -- although I often wonder why "free speech" costs billions of dollars...

AMA Study
The American Medical Association, perhaps recognizing the political realities, has stopped short of requesting an outright ban on drug advertising, although many of their members would probably like to see one. (You can be sure that most doctors do not appreciate their patients showing up with a diagnosis and drug solution in hand!) The AMA has set up a study committee to explore the impact of advertising on treatment. It will be interesting to see just how radical a position the AMA eventually stakes out.

In the meantime, I look forward to tracking the industry's self-imposed reforms. I will certainly keep my eye out for more balanced ads, carefully scripted scenarios which emphasize education about symptoms and which balance the positive effects of the drug with cautions about any potential side effects. I do have a vague suspicion that the new ads will be indistinguishable from the old: curing every possible ailment, real and imagined, making the user indescribably happy and promising the good life forever.

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June 21, 2005


The aging of the American workforce is a dynamic that we have been tracking closely. I can personally swear that as one ages the body begins to wear down. Oh, that this truth were not so.

In my father's day, it was common for people (mostly men) to work until age 65 and then retire on the proverbial company pension augmented by social security benefits. That changed dramatically toward the end of the twentieth century.

In the mid to late 90s, the goal became to retire early; age 55 would be nice. The dot-com bubble suckered us all into thinking it could be done. In 1998, a Gallup survey, conducted for USB Financial Services, found that only 36% of respondents planned to wait to retire until age 62 (pdf). But the horror of 9/11, the war on terror, the stock market collapse of 2001 that substantially reduced portfolios and the myriad Enron-type scandals that blew away entire pension funds all hit older workers smack dab in the middle of their futures. And when Gallup conducted the same survey in 2002, the percentage of workers who planned to put off retirement until after age 62 had grown to 47%. In 2004, the number had ballooned to 57%.

So, now we've returned to my father's time, except without the pensions and with significantly delayed and threatened social security. Older workers will continue to get older on the shop floor.

Do you think that the workers' compensation system is prepared for this? Age isn't considered in workers' comp manual rating. (Neither is education, but we'll leave that for another time.)

Rotator cuff sprains and aging
Here's something to think about. The rotator cuff sprain (something I know a great deal about) ranks 28th in terms of injury frequency for all workers, but 3rd for workers age 65 and above. In fact, 3 of the top 4 injuries to older workers are of the soft tissue variety to the shoulder, neck and lower back. To see a dramatic example of how bodies really do break down over time consider the following NCCI chart, which depicts the frequency of rotator cuff sprains by different age groups.

When valued at 18 months, the rotator cuff sprain of an older worker costs about a third more than for any other age group, $28,360 versus $21,910 for all other age groups. Moreover, every one of the top ten injuries to older workers costs substantially more than the same injuries among younger workers. And this situation will get worse as more and more older workers are literally forced by financial circumstances to stay on the job.

We believe that this phenomenon is so serious an issue that it may ultimately impact the way manual rates are calculated.

The impact on employers
As if running an American company weren't hard enough already, what does this mean for employers?

It's a problem. On the one hand, older workers have been doing their jobs for a long time; they're good at them, and they have experience that just can't be found in their younger colleagues. On the other hand, although younger workers have more injuries, those injuries are substantially less costly than their older mentors.

A knee-jerk, and very discriminatory, response might be for employers to try to "weed out" the older population and replace it with its younger version. We can only hope no employer starts the long walk down this painful and litigious road.

We'll continue to think about this issue and report on it in subsequent blog postings. As always, we invite your comments. But for now, we advise employers with aging blue collar workforces to re-double their safety and ergonomic efforts in order to provide as much protection as possible for these very skilled and experienced, but potentially brittle workers.

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June 20, 2005


If you were to Google the name "Dr. Jayant Patel," you would find over 20,000 references going back a number of years. The more recent entries are undoubtedly the most alarming. "Dr. Death" has been implicated in the demise of 87 patients at a municipal hospital in Bundaberg, Australia. He has become infamous for not washing his hands between surgeries, for failing to use anesthesia during surgery and perhaps most famously, for performing a colostomy backwards (I'm not sure what that would look like, and I don't really want to know). If you do take a few moments to google his name, you would be more diligent in researching the doctor than were his previous employer and the executive recruitment firm that brought him to Australia. Therein lies our tale.

Bundaberg is a farming community on the eastern coast of Australia, just south of the Great Barrier Reef. They are famous for "Bundy Rum" -- an alcoholic beverage that presumably bears no relationship to the star of the dubious sitcom, "Married with Children." The local municipal hospital was delighted to find a former professor of surgery at the State University of New York who was willing to relocate to Australia. Unfortunately, his tenure down under was not unlike his work in Oregon and New York. He had been suspended in New York and his license had been revoked in Oregon, where he had once worked for Kaiser Permanente.

Whistleblower Blown Off
One of the striking aspects of the story as presented in the New York Times (registration required) involves the head nurse at the hospital, Toni Ellen Hoffman. She continuously raised her concerns about Dr. Patel's performance with hospital administrators, only to be told that she had a "personality problem." After a particularly shocking incident, where a 9 year old girl watched her father die through Patel's neglect, the nurse requested an inquiry. The administration's response? They named Patel as the employee of the month!

Finally, as the result of a legislative inquiry, Dr. Patel's name was published in a paper. An enterprising reporter Googled the name and the scandal finally exploded. Dr. Patel fled the country, returning to Oregon where he lives in a mansion and appears to be unenthusiastic about returning to Australia, where he could face charges of homicide.

Management Lessons
We often talk about the potential negligence involved in hiring and entrusting incompetent or dangerous people to carry out their responsibilities. Here we certainly have a case of negligence in hiring: the hospital in Bundaberg was so excited to find a credentialed foreigner willing to join their staff, they did not look beyond the documents he presented about himself. As we have seen, a simple Google search would have exposed Patel as both incompetent and dangerous.

In addition, Patel carried letters of reference from several of his Oregon colleagues. These letters were provided after his termination for cause; the doctors who wrote them are likely to find themselves involved in the many lawsuits that are going to come out of this situation, under the legal concept of "negligent reference." Then again, perhaps the colleague who described Patel as "above average" has a very low opinion of the average doctor!

Beyond these examples of negligence, hospital administrators really messed up when they failed to respond to the alarms raised by a trusted member of the staff. The administration went into a denial mode that will severely compound their negligence in hiring: it's bad enough to drop the ball on reference checking, but far more serious to ignore the evidence right in front of your eyes. The lawyers will have a field day.

Some are calling Patel a psychopath. Others think he is simply incompetent. The bottom line is that he did not belong in any operating room, anywhere in the world, including one in a relatively remote town on the shores of Australia. With the advent of the internet, the HR folks in Australia had access to the same data available in New York City. So here's our advice: google new hires. It doesn't cost anything, it only takes a few moments, and it might save you a whole lot of pain, suffering and trouble.

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June 17, 2005


We recently blogged a study in mental health that concluded that nearly half of all Americans will suffer from some form of mental illness during their lifetimes. Whenever this type of information is disseminated, it gives rise to inevitable skepticism. When the percentages are high ("nearly half of all Americans"), the numbers may lack credibility.

It turns out that the definition of mental illness is a subject of debate within the psychiatric profession itself. An article in the New York Times (registration required) by Benedict Carey discusses the fault lines within the psychiatric profession. Carey notes that "the boundary between mental illness and normal mental struggle has become a battle line dividing the profession into two viscerally opposed camps."

On one side are the doctors who say that mental illness should be defined in broad enough terms to include relatively mild conditions, which they believe often lead to more severe problems later. On the other side are the doctors who want current definitions to be tightened, to ensure that resources are focused on the people who need them most. These latter doctors are concerned that when the definitions are too broad (as is perhaps the case in the recent study), the general public (and perhaps the occasional blogger) has a tendency to scoff at the findings.

Defining Mental Illness
There is a lot at stake here and as always, insurers are caught in the middle. The battle ground may well be the pending revision of the American Psychiatric Association (APA)'s diagnostic manual -- the catalog of mental disorders on which treatment and the profession itself are based. The next edition is due out in 2010 -- and right up until the printing deadline there will be debate about where to establish the cut-off points for clinical disease.

Diagnosing mental illness can be similar to working on certain types of lower back pain. In the absence of any objective findings, the doctor is limited to observations of behavior and the patients' own answers to basic questions: how do you feel? How bad is it? What effect is it having on your life?

Ultimately, this comes down to the issue of severity: what effect does the condition have on an individual's ability to function at home, in public and in the workplace? Magellan Health Services, a major provider of mental health insurance, has developed standardized tests to determine the degree of impact on someone's life. They also have a report on "common warning signs," which I would very much like to read. Unfortunately (and I caution you not read too much into this), the PDFs for this report appear to be inaccessible, at least at this time.

Mental Illness and the Workplace
Just as physical health impacts one's ability to perform certain jobs safely, relative mental health can impact safety as well. This is an area where most employers rightfully fear to tread. On the one hand, the workplace may be a danger zone for people who are experiencing mental disorders. On the other hand, the workplace is part of the safety net for all of us -- we often rely on the consistency and certainty of work to define ourselves and to stabilize our identities.

So when confronted with bizarre or unusual behavior, what should employers do? The Canadian Psychiatric Association has put together a useful brochure on "mental illness and work." This document includes some basic guidance for employers in handling employees who may be suffering from mental illness. They recommend approaching employees with flexibility and compassion. As with any situation requiring accommodations, the answers often emerge from candid and confidential conversations with the workers themselves.

The Times article quotes a 48 year old business analyst who developed panic attacks to the point where he dreaded even small meetings with friendly coworkers. "It's very bizarre; the only way I can describe the feeling is, Imagine walking down the street at dusk having someone put a gun in your face and threaten to kill you - having that absolute terror before a routine work meeting."

It's not hard to imagine that such a phobia would directly impact this person's performance at work. Indeed, a typical employer would be likely to document the performance issues and eventually terminate him. Fortunately, this man's wife had watched a therapist talk about social phobia on television, which led directly to his getting help. This is a case of a mental illness that gradually approaches and then passes the threshold where it impacts the individual's ability to function.

It will be interesting to track the APA's progress in revising the diagnostic manual. The final wording will directly impact how we perceive certain behaviors -- and what behaviors will be considered "compensable" by insurers. Polls, studies and definitions aside, we may never be able to determine what percentage of Americans suffer from mental illness. But one thing is certain: the drama of untreated mental illness will play itself out in the narrow confines of families, in public spaces, and in workplaces across America.

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June 16, 2005


Folks at the Ohio Bureau of Workers Comp (BWC) desperately need to remember the first rule of holes: when you are in one, stop digging. Today, reports are that the BWC is considering $80 million in givebacks to employers in the form of an 8 percent dividend in a misguided attempt to demonstrate solvency. Last month, the BWC voted to raise rates by an average 4.4 percent beginning July 1. This "pay no attention to the man behind the curtain" scheme would be a knee-jerk response to the ever-widening scandal that now encompasses the loss of hundreds of millions of dollars in state funds. Nearly every day finds a new shoe being dropped. Some of the revelations are boggling:

There are many other bizarre twists and turns that span several states, such as stolen wine, guns, and jewelry in Colorado and vacation homes in Florida.

We hope the BWC will drop the idea of employer givebacks until totally independent parties have assessed the full scope of the mess. Sadly, Ohio BWC has already broken faith with taxpayers, with employers that pay premium into the fund, and with injured workers for whom the monies are held in trust. Now it's time to stop digging.

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June 15, 2005


A couple of new studies reinforce a number of concerns that we continue to raise concerning the aging of the American workforce. NCCI has released a study (PDFs) that specifically addresses the potential impact of an older workforce on workers compensation costs. Not surprisingly, they find that older workers get injured less often than younger ones, but when they do get hurt, their recovery times are slower and the cost of the claims is higher. The NCCI study focuses on the specific injuries that generate the most dollar losses among older workers: rotator cuff strains, lumbar disc problems and carpal tunnel syndrome. (We alerted readers in a prior blog that workers over 50 should be very careful when performing jobs above the shoulder level.)

The specific risks associated with older workers need to be examined in the context of changes in the overall workforce. The Workers Compensation Research Institute (WCRI) has published an interesting study on Return-to-Work Outcomes in four key states: California, Massachusetts, Pennsylvania, and Texas. WCRI found that workers over the age of 55 who are injured are 12 to 35 percent less likely to return to work when compared to workers between the ages of 25 and 39. In addition, these older workers are out of work 62 to 276 percent longer. (I would like to quote from the study at length, but the information is proprietary and protected by copyright, so I am limited to quoting from their press release.)

One Side of the Story
WCRI’s study included data from approximately 750 injured workers in each of the four states. The data is based on workers with more than seven days of lost time who reported having a substantial return to work (they returned for at least a month) or who reported having no substantial return to work during this time. I think it is worth noting that the data is based solely upon worker interviews, which took place three and one half years after the injury. At some point I would hope that WCRI would expand their study to include interviews with the former employers of the injured workers. I would really like to know whether the employer tried to get the injured employee back to work; whether there were modified duty opportunities available to the worker; and whether the employer maintained any contact with the employee during the disability. In a word, how hard did the employer try to get these people back to work?

By 2012 there will be over 10 million more workers older than 55 than there are in the current workforce. As the “baby boom” generation continues to age -- and as it is confronted with the financial realities of retirement -- the number of workers age 55 and older is projected to grow by 49 percent. This is four times the growth rate projected for the overall U.S. labor force. Turmoil in the economy may actually increase these numbers: failed pension plans, inflation, instability in an eroding middle class all increase pressure on older people to keep on working.

Education Levels and Duration of Disability
Here is the real bombshell in the WCRI study: a worker’s education level is a key factor in the likelihood of return to work and the duration of the out of work spell. Workers with a high school education returned to work 10 to 60 weeks faster than those with less education. In other words, one of the stongest predictors of no return-to-work is a lack of education: for workers with grade school education only, the duration of disability is significantly increased.

We are seeing a convergence of factors that may indeed become a "witches brew" for trouble in workers comp. We have an aging workforce. People are under pressure to work deeper into what used to be retirement years. Many older workers lack formal education, so they are less likely to have readily transferable skills. When their aging bodies fail, what are they going to be able to do? The pressure to keep on working might be fine for those of us doing white collar work, but what does that bode for the millions who must depend upon their physical strength and flexibility to perform the work? What would you do if you were in your 60s, after a lifetime of hard work, confronted with chronic problems in your knees and shoulders, with no pension and little saved for retirement? What exactly are your options?

In a future posting, we will share some thoughts on the steps employers can take to minimize the risks in employing older workers.

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June 14, 2005


I remember an ad from some years ago showing a guy using a laptop at the beach. At the time, this was designed to paint some futuristic fantasy of ubiquitous computing. I clearly remember how the ad alternately intrigued and horrified me. As a bit of a web geek, I loved the idea of mobility. On the other hand, the luddite in me balked. I'm not always keen on the blurring of the line between work and personal space. Nice to work at home now and again, yes. Not always quite so nice to have work follow you when you are enjoying a Margarita on the beach.

Today, mobile computers are the fastest growing segment of all computing devices. About one in every four computers purchased last year was a notebook. That's a whopping total of more than 45 million new laptops. More and more workers are mobile today. People are working from the road, working from home, and yes, they are probably working from the beach. Mobile computing affords both employer and employee freedom from the constraints of geography.

But as Newton told us, for every action there is an equal and opposite reaction. The downside to this mobile nirvana is an upsurge in laptop-related ergonomic maladies. In a recent article, Is Your Laptop a Pain in the Neck?, Alorie Gilbert of CNET News discusses this phenomena.

Essentially, laptops were never designed to be permanent workstations. Good workstation ergonomics dictate that the optimal place for the computer screen is just under eye level, and that the best place for a keyboard is at wrist level. With a laptop, you can have one but not both. They violate just about every aspect of the CDC's ergonomics guidelines, and then some.

Strains, sprains, and …. infertility?
Regular laptop users can experience neck and back strain from poor posture. Cramped keyboards and mouse buttons can do a number on wrists and hands, leading to repetitive stress injuries. There have also been reports of burns from the heat of a machine. And if all that isn't bad enough, the temperature of a notebook on the lap can also cause fertility problems. (Now there's an interesting liability claim waiting to happen.)

If you are only using a laptop now and again for short periods of time, risk is likely to be minimal. But if you are using a laptop as your main computing device, and you are online for much of your workday, you may be in trouble. Woe to us bloggers.

There are many steps you can and should take to minimize your (or your employee's) risks by improving the ergonomics of your laptop workstation. Here are a few tips from experts:

  • Take frequent breaks and do stretching and flexing exercises.
  • Whenever possible, use a docking station and a separate keyboard.
  • Avoid a right angle setup - tilt the laptop so the screen is leaning back.
  • Use heat-resistant pads to shield your lap.
  • If you are accustomed to carrying lots of material along in your computer case, consider a wheeled cart for transport.

Additional resources:
Ergo tips - workstation design
Blackberry thumb
5 tips for using a laptop computer
Laptop ergonomics

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June 13, 2005


A fascinating article by staff writer T. Christian Miller in today's Los Angeles Times (registration required) focuses on the cost of providing workers comp insurance to non-military employees in Iraq. Under a WW II era program called the Defense Base Act, private insurers charge the government for comp premiums. These private carriers are at risk only for the non-combat related injuries, illnesses and deaths. The government reimburses the carriers for all combat-related incidents, plus a 15% admin fee. Overall, costs for comp in Iraq are somewhere around $ 1 billion, but no one seems to know for sure.

Currently, two carriers dominate the market: AIG and ACE. The Pentagon is talking about awarding all the business to a single carrier, in order to contain the escalating costs. The counter argument seeks a continuation of the "free market approach." I'm not sure how "free" the current market is and as for the rates, they appear to be headed in the wrong direction.

Comp in Iraq
There are about 30,000 Americans and third-country nationals and more than 40,000 Iraqis working on U.S. contracts in Iraq. To date, about 300 contractors have been killed and 2,700 injured. When the program began, insurance rates ran between $4 and $8 per hundred dollars of payroll. Now they are up to $20 per hundred -- a pretty hefty rate by most measures.

Salaries in Iraq, as you would expect, are much higher than those in the states. It's not unusual for workers to pull down $100,000. (The pay is good, but you would have to characterize the working conditions as marginal.) Comp premiums at the $20 rate would average about $20,000 per employee -- a very high rate indeed. Because of the high salaries, death claims are averaging between $1.2 and $1.8 million -- significantly higher than death claims for workers in the states.

How do rates for insurance in Iraq compare to other locations in the world? Here's one striking example cited by Christian: In Colombia, a contractor flying helicopters in support of State Department drug interdiction programs is charged at $3.87 per $100 of payroll -- less than a truck driver in the states. In Iraq, however, a contractor flying helicopters runs $90 per $100, with comp payments almost the equal of payroll (only iron workers above the 6th floor reach anywhere near comparable rates in the states). Keep in mind that if the helicopter pilot dies in a combat-related incident, the carrier is not on for the loss. The carriers respond by saying they have to establish these high rates, because even if they are eventually reimbursed for a combat-related incident, it could take several years to actually get the money and there is no guarantee that the government will accept the liability.

Conventional Cost Control, Unconventional Conditions
Employers in the states have learned the hard way that the best way to control comp costs is to contain losses. Cost containment means committing to good safety programs and setting up a system for immediately responding to injuries. You need to establish a relationship with an occupational medical provider and set up a comprehensive return-to-work program that uses temporary modified duty to speed recovery. That's all well and good stateside, but I have to wonder how well that kind of a system will work in Iraq. Is anyone motivated to implement modified duty? Do employees really want to go back to work, or would they prefer to collect 2/3 of their (inflated) average weekly wage at a safe distance from the turmoil? If you were an Iraqi national, would you risk your life going back to work on temporary modified duty? With U.S. taxpayers ultimately footing the bill, does anyone over there really care if an injured employee goes back to work? When you think about it this way, you wonder why carriers would want any of the risk.

Where's OSHA?
I wonder what OSHA would say about the working conditions in Iraq. (Given the reduced number of inspectors, they probably haven't gotten there yet.) Under the General Duty Clause, employers must provide a workplace free from the risk of injury and illness. How does Iraq stack up? As a spokesman for one of the carriers stated, in response to questions about the high rates, "it's 130 degrees. There is a lot of dust. There is a lack of hospitals." Not to mention the fact that strangers are constantly trying to kidnap or kill you. Stress claim, anyone?

Ubiquitous AIG
It is indeed interesting to find AIG in the middle of this high-risk mess. Just as they were challenged by New York Attorney General Elliot Spitzer for "risk transfer" transactions that apparently involved no risk at all, it appears that here in Iraq they are collecting possibly inflated premiums where, once again, a substantial portion of the risk lies with others (you and me, to be exact).

Ultimately, my sympathies here are with the workers. I can hardly imagine a more difficult place to work. Here in America it's rare to dress for work with a prayer that you will survive another day (rare but certainly not unheard of). In Iraq, every breath in that hot, dusty place is accompanied by just such a prayer. Here's wishing a safe return to our civilians and a lasting peace for the Iraqi people themselves.

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June 10, 2005


The National Institute of Mental Health recently issued the findings of its $20 million study of mental health in the United States. Parallel studies are taking place in 27 other countries, but even though these studies have not yet been completed, the National Institute of Mental Health is ready to declare us the winners. "We lead the world in a lot of good things, but we're also leaders in this one particular domain that we'd rather not be," said Ronald Kessler, the Harvard professor of health care policy who led the effort, called the National Comorbidity Survey Replication (PDFs here).

News Coverage
I am as fascinated by the way the study is being presented in the media as by the study itself. Just take a look at some of the headlines gleaned from newspapers and the internet:
"U.S. Leads in Mental Illness" (Washington Post)
"U.S. Mental Health Holding Steady"(Science Now)
"U.S. Mental Survey Depresses Experts" (Nature.com)
"Mental Disorders Strike Nearly Half of All Americans"
"Little Change in Suicidal Thoughts or plans in U.S. " (Medical News Today)
And the winner is:
"Survey Says Person Next to You is Nuts" (Web Pro News)

The study involved face to face interviews with over 9,000 individuals. The surveyers were carefully trained. The questionnaires were detailed and comprehensive. I am not sure how you can extrapolate the mental health condition of 296 million people by surveying .00003 percent of them, but I'm neither a mathematician nor a mental health expert, which is probably just as well.

The study found that less than half of those in need of mental health services get treated. Those who seek treatment typically do so after a decade or more of delays, during which time they are likely to develop additional problems. And the treatment they receive is usually inadequate. The study projects that almost half of Americans (about 145 million people) meet the criteria for illness at some point in their lives, but acknowledges that most cases are mild and do not require formal treatment. Every year about 6 percent of adults are so seriously affected that they cannot perform even routine activities for periods averaging three months.

The report speculates that this lack of appropriate intervention results from a number of causes, including the failure to recognize early warning signs, inadequate health insurance (I would add, routine exclusion of mental health services by health insurers) and the lingering stigma that surrounds mental illness. Indeed, once people are perceived as having a mental problem, they may not be able to escape being seen in that light.

Thomas Insel, chief of the National Institute of Mental Health, said the nation needs to recognize that mental illness is a chronic condition that requires expert medical attention just as heart disease, Alzheimer's and diabetes do. Intel was disappointed to learn from the survey that despite the availability of effective treatments for many mental illnesses, about a third of people in need rely solely on nonprofessional sources such as Internet support groups and spiritual advisers.

"You wouldn't rely on your priest for treatment if you had breast cancer," Insel said. "Why would you go to your priest for a major depressive disorder? These are real medical and brain disorders, and they need to be treated that way." [Disclaimer: reading the Insider will do nothing for depression and may on certain days actually increase anxiety.]

Implications for the Workplace
The study does not attempt to project the number of American workers trying to perform their jobs while suffering from mental disorders. But if nearly half the population has a problem at some point in their lives, then the workplace must be pretty well saturated with potential issues. We have a long way to go in recognizing how mental health impacts job performance and in developing meaningful interventions. When you're Number One, it's lonely -- and sometimes even dangerous -- at the top.

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June 9, 2005


Most of us can remember some grade school nightmare involving a bully. My nemesis was a seemingly innocuous and almost cherubic looking boy who had the soul of Attila. There wasn't a single kid in the school or pet in the neighborhood that didn't feel the toe of his boot, either literally or figuratively. It really wouldn't surprise me in the least if I were to learn he had orchestrated all the shameful doings at Abu Ghraib. Or perhaps you might know him - maybe he's your boss.

Diane Lewis of the Boston Globe recently wrote a lengthy piece on the topic of bullying bosses using the controversy about John Bolton as her lead. As a parade of former colleagues and subordinates line up to protest his appointment as an ambassador to the U.N. on the basis of his temperament, I wonder if he wishes he had spent a bit more time honing his people skills?

The Bolton nomination seems to be enjoying some popularity as a springboard for a discussion about abusive bosses. See Amy Joyce's recent article, Big Bad Boss Tales, in the Washington Post for a rogues gallery - a badness hall of fame, so to speak.

Lewis cites a study by Wayne State University that indicates that one out of every six workers are bullied by bosses in any given year. A study by Workplace Bullying and Trauma Institute found that 71 percent of workplace bullies outranked their victims.

Bosses aren't the only bullies
The National Institute for Occupational Safety and Health (NIOSH) released a recent study on workplace bullying that has a somewhat different take on the matter. Their findings showed that bullying was more likely to be peer to peer than manager to worker. Of the 516 respondents, 24.5 percent reported that some degree of bullying had occurred at their workplace during the preceding year; 39.2 percent named an employee as the aggressor, 24.5 percent said the bullying involved an outside customer/nonemployee, and 14.7 percent involved a supervisor.

Whether the source of the bullying is a supervisor, a coworker, a customer, or the head honcho in the corner office, it can have a serious and pernicious effect on the work culture, eroding trust and goodwill. It can also be expensive. Not only will angry, sullen workers be less than productive, they may find a sympathetic hearing in court for harassment or for being victims of a hostile workplace. And if a work injury occurs, egregious behavior or misconduct on the part of a supervisor might pierce the shield that generally holds workers comp as the exclusive remedy. While "no fault" is the operating rule, when serious misconduct can be established, all bets are off. And it should be particularly noted that most states take a decidedly dim view of any retaliatory actions for claims that have been or might be filed.

Rooting out a bully culture
Employers need to take a hard look at their company culture and root out any bullying behavior. We like to think most employers want do the right thing. We believe that most people aspire to excellence, but sometimes just have trouble getting there - the devil is in those pesky details.

Presidents, business owners, and CEOs must take a leadership role by setting the tone and establishing and enforcing "zero tolerance" policies. Supervisors should be trained in conflict resolution, anger management, and preventing harassment. A system for reporting, investigating, and resolving complaints should be established. Employees should be informed of how to report a complaint, and be assured that they will not be retaliated against for doing so. While HR should play a key role in this process, it might be beneficial to have an Employee Assistance Program (EAP) on board, too, so that employees have recourse to an external source if they are too intimidated to pursue a complaint internally.

More reading on the topic of bullying:
Beware: Bullies at work
Are you working for a bully?
Bullies at work
Rough, raunchy or rude: Workplace bullying increases health care costs, lowers productivity
Workplace Bullying & Trauma Institute

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June 8, 2005


Insurance giant AIG is reeling from revelations of improper accounting practices. Maurice Greenberg, the legendary and autocratic driver behind the company's success (#106 on the Forbes list of wealthiest people), was abruptly removed from his post. In the midst of this classic and prolonged "public relations nightmare," the company is trying to rebuild public trust. One step is a turn toward the arts.

The current issue of the New Yorker contains a full page add for the company, along with a small booklet of poetry entitled "Well Versed: poems for the road ahead." You don't often find major corporations looking to poetry for sustenance and growth. So it's only fair that we take this effort seriously. In fact, I find myself reading these poems in the context of AIG's recent turmoil.

Robert Frost's "The Road Not Taken"
We've all read of the "two roads diverging in the yellow wood" and the choice confronting the narrator. Which road to take -- the well traveled or the less well traveled? "I took the road less traveled by,/and that has made all the difference." Ah, but which road did AIG take and what difference did that make?

Rudyard Kipling's "If"
You probably remember the opening lines: "If you can keep your head when all about you/Are losing theirs and blaming it on you..." Sage advice, from a presumed father to his son. I wonder if the new leadership at AIG has taken these lines to heart: "If you can meet with Triumph and Disaster/And treat those two imposters just the same/...Or watch the things you gave your life to, broken,/And stoop and build 'em up with worn-out tools;/..If you can talk with crowds and keep your virtue,/Or walk with kings-nor lose the common touch..." For all its success over the past decade, no one ever accused AIG's leadership of having a "common touch." Perhaps the new leadership will set this as a goal.

Edna St. Vincent Millay's "First Fig"
"My candle burns at both ends;/It will not last the night;/But ah, my foes, and oh, my friends-/It gives a lovely light." I am tempted to connect this unsafe candle burning practice with accounting procedures at AIG, but I won't.

The collection includes a number of frequently anthologized poems, along with a nice selection from contemporary poets such as Philip Booth and Lucille Clifton. Most of the poems seem to offer some form of advice or faith in facing an uncertain future. Poetry is good at that: helping us look ahead without telling us exactly what to expect. Reminding us to center not on greed or duplicity, but on the values that really matter.

I'd like to think that in the midst of AIG's crisis, someone actually read these few poems at AIG's board meeting, but I'm not that naive. I suspect that board members have no awareness whatsoever of this particular PR project to recapture the public trust. Too bad. A little time for poetry in the board room might help companies avoid the type of mess that AIG finds itself in. Good luck to them, and good luck to the rest of us, too.

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June 7, 2005


Have you checked out our resource sidebar lately? Besides our "blogroll" of weblogs we find interesting or related, we have also compiled a lengthy list of publications and resources that offer one-stop-shopping for all your industry news. Here are a few recent news items we've noted:

If you haven't done so, check out the site redesign at Business Insurance. It's a much cleaner, brighter look, and the site seems easier to navigate. The center column is updated with daily news items, and has a blog-like format. The top story today is Judy Greenwald reporting on a Gen Re executive's guilty plea to a conspiracy charge in connection with a reinsurance deal 4 years ago on behalf of AIG.

Peter Rousmaniere examines the ways that information technology changes how we manage work injury risk in this month's issue of Risk and Insurance. Four words: easier, faster, better, cheaper.

The editors of Behavioral Healthcare Tomorrow have issued 2005 Almanac for Mental Health & Addiction Professionals. It provides an annual roundup of statistical trends in mental health and addiction. One section of the report examines social costs and expenditures associated with adult mental illness and substance use disorders, as well as at treatment trends and outcomes in adult care.

Workforce Week is a great HR publication that's always worth a look-see - we've been remiss in not adding it to our resource sidebar but will now do so. The current online issue has an article on the Temp-to-Hire trend that is becoming a full-time practice at many firms.

The recent issue of Risk Factor features an article on obesity in the workplace by Lori Widmer.

Mike Moody has a good article on captives in this month's issue of Rough Notes. And while at the site, check out the new digital issue format that is being introduced. Rough Notes has long been a pioneer in putting so much substantive content online - you can access back issues as early as 1997!

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June 6, 2005


When I read that the IWW (Industrial Workers of the World) was trying to organize workers at a Manhattan Starbucks, I thought for a moment that I was stuck in a time machine. The IWW still exists? Indeed, the "wobblies" are still with us. They have a website, resplendent in red and full of interesting information. This year marks the union's 100th anniversary, which, I think it is safe to say, is a little past its peak in terms of interest and participation. They still have articles from two of their most famous supporters, writers Jack London and Helen Keller. A quick review of the archives shows that the truly famous drop off sometime around 1920, but the mission over the next 80 years does not change: the IWW will be satisfied with nothing less than an end to capitalism.

The IWW press release raises some classic issues of poor working conditions, some of which will ring true with those who study the ergonomics of fast food. Starbuck workers serve an enormous volume of beverages, many of them extremely hot. The union claims that in order to save money, management refuses to schedule enough workers to do the required work safely. Instead, workers are forced to perform their duties at unsafe speeds with an undue level of physical exertion.

"A Starbucks coffee shop is an ergonomic minefield. The stores are supposed to mimic an Italian cafe without considering the uncomfortable bending and reaching we have to do, " explained Barista Anthony Polanco. "This is not your mom and pop coffee shop. We are talking McDonalds busy every day. Starbucks talks about "Creating Warmth" but the only warmth I feel is the heat pad at the end of the day."

Coffee, Coffee Everywhere
Starbucks is a $15 billion company with over 7,500 locations around the world. According to the union, in New York City Starbucks workers start at $7.75 an hour and eventually receive paltry raises. The union accuses Starbucks of developing a scheme whereby all Baristas work on a part-time basis and are not guaranteed a set number of hours per week, thus making it exceedingly difficult for workers to budget for necessities like rent, utilities, and food.

The union doesn't address the issue of benefits directly, but it appears that half time (20 hours per week) workers qualify for a fairly robust benefits package, including health, dental and retirement. These benefits certainly have the potential to separate Starbucks employees from those in other fast food industries. However, there may be an issue with scheduling -- a few disgruntled employees claimed that managers deliberately scheduled them for just shy of the required 20 hour average, so they were unable to participate in the benefits plan.

Walmart and Starbucks
There may well be some important similarities in all companies seeking to carve out humongous market shares across the globe. Rapid growth is fueled by aggressive pricing (well, I would not say that Starbucks sells a discounted product!), anticipation of consumer demand and, I'm sorry to say, ferociously contained labor costs. One Starbuck employee wonders why it has become fashionable to boycott Walmart for its labor practices, all the while stopping by the local Starbucks for the stimulant of choice. Interesting question, one which cuts into the very heart of the culture wars. Perhaps the privileged classes can survive without Walmart, but not without their Java.

Still, I like to imagine a couple of wobblies huddled for several hours in overstuffed armchairs at their neighborhood Starbucks, nursing a frappachino latte whatever and plotting the end of capitalism. That is still and ever will be the American way.

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June 5, 2005


Actuary.net points to an amusing survey on Actuarial Outpost about career choices: Machinist or Actuary? Perhaps I should qualify that to say that it's amusing if you work in insurance ;-) It brought to mind an actuarial jokes website that I chanced on some years ago when there was precious little in the way of insurance posted on the web. It's fun to see that not only is this "pioneer" site still up, but that Jerry Tuttle has been nurturing it along since at least 1998 and the site now boasts more than 150 jokes. For a light bit of weekend reading, here's a sample:

  • An actuary, an underwriter, and an insurance salesperson are riding in a car. The salesperson has his foot on the gas, the underwriter has his foot on the brake, and the actuary is looking out the back window telling them where to go.
  • What is the difference between an introverted actuary and an extroverted actuary? An introverted actuary stares at his own feet during a conversation, while an extroverted one stares at the other person's feet.
  • An underwriter takes his two actuaries into a restaurant. The waiter asks the underwriter what he would like to eat, and the underwriter says, "I'll have the steak." Then the waiter asks the underwriter, "And for your vegetables?" The underwriter replies, "They'll have the steak too."

Now it's all well and good to take potshots at the actuaries among us (no doubt they have amusing stories about marketers), but in workers comp, we depend on them for ratemaking, reserve adequacy, and providing models to predict the impact of any legislative changes. For those who would actually like to learn more about the role that an actuary plays and what the job entails, visit the actuarial entry on Wikipedia or the Bureau of Labor Statistics page on actuaries. Also, a few professional associations jointly sponsor the site Be An Actuary, which offers quite a bit in the way of career advice.

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June 3, 2005


Back on April 22 we blogged the new food pyramid model and a surprise finding from the AMA Journal that a little obesity might actually help you live longer. That particular study found that skinny people were at higher risk for death than those who were somewhat overweight. So it was time to break out the Twinkies and have a party, right?

Not so fast. It turns out that a little obesity is still a bad thing. On June 2 the Centers for Disease Control held a briefing that essentially retracted the findings of that earlier study. Dr. Julie Gerberding, head of the CDC, is quoted as saying: "we want to be very clear--obesity and overweight--and I'm sorry to say overweight because I know a lot of people were hoping that CDC was going to come out and say it was okay to be overweight but we're not saying that. It is not okay to be overweight."

Got that? Overweight was, is and will be a bad thing. Gerberding goes further, asserting that "people need to be fit ,they need to have a healthy diet, and they need to exercise and overweight is a very important health issue in and of itself, but also overweight is a major predictor of future obesity." In other words, don't let that gym membership lapse any time soon.

Good Data Gone Bad
Naturally, the question that interests the Insider most is how did this unfortunate endorsement of obesity come about? This isn't exactly Enron -- so cooking the books doesn't raise the value of anyone's stock. (Then again, did anyone track the value of fast food stocks when the initial report came out?) Where exactly did the data crunchers go wrong? It turns out that in studying morbidity, the research data brought in a large number of people who died of from chronic conditions, for example, people who had end-stage cancer or an immunodeficiency. These terminally ill and finally deceased people very often are, by the time they die, significantly underweight. As a result, the deaths involving the chronically diseased skewed the data in favor of moderate obesity, which creates health problems but does not generally kill people outright.

So when you just compare death rates of "skinny people" to people who are slightly overweight, you can get a paradoxical finding. It's literally true, but it really has nothing to do with the root causes of mortality. (Kind of like saying that every accident is the result of "carelessness.") The Insider is somewhat shocked that the earlier study was released without further scrutiny. Fortunately, we did not adjust our dietary intake to accommodate the counter-intuitive findings. So we'll continue to pass on the General Gau's Chicken (sigh) and stick with the steamed vegetables. Bon appetit!

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June 2, 2005


We ordinarily focus on the world of commercial insurance, but I cannot help but wonder what property insurers are going to do about the multi-million dollar homes that recently slid down a cliff in Laguna Beach, California. The LA Times has a summary of the event, which links to a compelling set of photographs. Fortunately, no deaths or serious injuries were blamed on the slide, which begain literally with a bang as wooden beams in dozens of homes just snapped. The slide, blamed on recent rains, sheared away part of the face of Laguna's Bluebird Canyon. At last count 17 homes were completely destroyed and 11 seriously damaged.

Here is my question. Let's assume that insurance companies accept the claims -- as opposed to denying at least some of them for lack of "flood" insurance. (A lot of rain does not equal a flood; it surely is "water damage.") Insurers will pay up to policy limits for the homes and their contents. But what about the lots on which the houses stood? The very expensive land on which these homes were built no longer exists. The palatial home perched on a hillside has crumbled into a muddy pit. Indeed, more that one homeowner might have a claim on the same flattened piece of real estate -- assuming, of course, that any rebuilding can take place. Will insurance cover the cost of replacing the lost lots? Or are homeowners on the hook for it? I reviewed conventional insurance offerings in California and found, not surprisingly, that they do not contemplate the risk of a building lot simply disappearing. I suspect that the homeowners may be on their own when it comes to paying for a new place to build their homes.

When in Doubt, Litigate!
Risk transfer is usually a pretty straight-forward business. But in this unusual California situation (rather likely to recur), risk transfer is nothing short of a soggy mess. With the workers comp market in that state finally tightening up, perhaps this is the opportunity that some local attorneys have been waiting for.

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June 1, 2005


Ever wonder why your loss costs continue to rise despite your organization's strong safety programs? Or why one of your company's locations has a much stronger safety performance than another? Larry Hansen does, and he has written an excellent and lengthy article entitled Stepping up to occupational hazards in this month's edition of Occupational Hazards that explores these issues. He singles out culture as the X Factor (or the 'excellence differentiator') in achieving stellar safety performance. Here's an excerpt:

"In his October 2003 Occupational Hazards article, "Getting the Culture Right," Don Eckenfelder contends that organizational attitude ultimately determines whether safety initiatives succeed or fail, and proposes three core truths: "1 - Culture predicts performance; 2 - Culture can be measured; and 3 - Nothing is more important than getting the culture right!" The culture of an organization - its basic beliefs and values concerning people - is what drives safety excellence.

Tom Peters and Bob Waterman spent a decade In Search of Excellence, attempting to discover what lies at the core of operational excellence. After years of research, they summarized their findings in a simple, yet powerful message to American management: "Figure out your values system!" Values lie at the core of an organization's culture, and are the predictors of, and ultimate determinants of, all operational outcomes ... safety included."

Hanson’s article goes on to describe four stages of safety that produce varying levels of effectiveness depending on how evolved a company is in their approach:

1. S.W.A.M.P. - safety without any management process, or "costs are the problem"
2. N.O.R.M. - naturally occurring reactive management, or "people are the problem"
3. Excellence - safety excels to the 4th quartile - safety is "managed"
4. World Class Safety - Safety is "non managed...safety is led"

The above offers just a brief recap, the article itself offers much more food for thought. Check it out to see how evolved your organization is in the safety hierarchy.

It's refreshing to see best practice management thinking applied to organizational safety, an area that is all too often given short shrift or that is delegated down. When it comes to safety, we ascribe to the Mahatma Gandhi philosophy of "Be the change you want to see." We firmly believe that no organizational change happens unless it starts with a commitment from the corner office and permeates every level of the organization.

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