September 2006 Archives

September 28, 2006

 

We recently blogged a ruling in the U. S. 6th District Court, in which the judges determined that morbid obesity is generally not a disability. The judges’s thinking in this particular case appears to have powerful implications for the ADA and for all employers with obese workers who have difficulty performing their jobs. HR professionals might be tempted to assume that morbid obesity is not a disability protected by the ADA. So if severely overweight employees cannot handle the job, you just terminate them, right? Not so fast!

Christopher Cornell examines some of the ramifications in the current issue of HR Executive (free registration required). [In the interests of full disclosure, the Insider is quoted in the article.]

The 6th district court assertion that most morbid obesity does not entail a disability was contained in a single footnote, written by a single justice. It would take a ruling from the U. S. Supreme Court (or an act of Congress) to have a definitive answer as to whether morbid obesity is covered by the ADA. Meanwhile, it would be foolish and counter-productive to incorporate the 6th district’s ruling into basic HR policies.

The Accommodation Process
Why does it matter? The EEOC brought the action against Watkins Motor Lines on behalf of Stephen Grindle, a 400 pound driver/dock worker. The EEOC appears to believe that morbid obesity is inherently a disability. If it is, employers would be required to “reasonably accommodate” obese workers through the ADA’s formal accommodation process. That means going through a specific series of steps to determine which essential job functions need accommodation and the degree to which the accommodations can be “reasonably” accomplished without “undue hardship” for the employer. If the employer cannot accommodate the worker in the current job, they are required to offer the employee any open and available positions for which the worker is qualified (at the same or a lower rate of pay). Only after going through these additional steps – and documenting each action - can the employer terminate a morbidly obese (“disabled”) employee.

If, on the other hand, morbid obesity is not a disability, employers would not have to go through this step by step accommodation process and document the results. If employees are unable to perform the job’s essential functions, you can just let them go, which is what Watkins Motor Lines did ten years ago.

To Accommodate or Not to Accommodate, That is the Question
So what should managers do? Despite the 6th district ruling, we believe that managers should assume that morbid obesity is still a disability and approach any situations involving obese employees through a formal accommodation process. First of all, some courts are likely to view morbid obesity as a disability. So if you terminate someone without going through the formal process and end up in one of these courts, you will lose. In the world of the ADA, process trumps results. In other words, even if your ultimate decision to terminate is found to be valid, you can lose your case simply for failing to follow the accommodation process.

In addition, accommodation is usually the right thing to do. You hired the individual because he or she had the needed skills for the job. The worker is able to handle some if not most of the job functions. In all likelihood, you value the contribution that the employee makes toward the success of your organization. It’s worth an effort to keep the person on board.

Working with Obesity
Employers have the right to define the nature and the essential functions of a job. So employers should keep their eyes on those essential functions. Make sure employees - disabled or not – can do the work safely. If you’re not sure, require the employee to undergo a “fitness for duty” functional capacity exam at a reputable occupational health provider. If employees cannot do the job, try to accommodate them: identify the functions they can handle; explore “off-loading” the activities they cannot perform safely to other workers. If that proves impossible – if the employee can no longer perform the essential job functions – then explore any open and vacant positions within the company for which the individual is qualified. (It’s easier and less risky to move an incumbent into a vacant position than to hire a stranger.) If there are no such positions available and none likely to become available in the near future, the employee can be (safely) terminated.

It’s important to note that even though Watkins Motor Lines eventually prevailed in their decision to terminate Grindle, it took them ten years and countless hours of work to do it. I suspect that if they had simply gone through the formal accommodation process back in 1995, they would have been much better off. Even if at the end of the process they had still decided to terminate Grindle, they would have demonstrated a good faith effort to acknowledge his physical issues and to work with him. In retrospect, that would have been cheaper, more efficient and fairer – in all, a solid management approach to what is fast becoming a widespread problem in the workplace.

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September 28, 2006

 

Week of the carnivals - This is a big week for the blog carnivals. Yesterday, we alerted you that this week's Health Wonk Review is posted. Now we have news that a fresh Cavalcade of Risk compiled by Joe Kristen of Roth & Company Tax Updates blog. it's a pretty hefty issue - something for just about everyone in the risk spectrum.

Are air marshals being dismissed over work injuries? - Last week, The Washington Times reported on the high number of injuries experienced by federal air marshals, claiming that 2,100, or nearly half the total work force, had been sidelined due to injuries. Many are quitting the Federal Air Marshal Services (FAMS) due to a variety of illnesses, such as deep vein thrombosis and barotrauma, a decompression sickness that causes ruptured eardrums and sinus conditions. Over about a three-year period, nearly 2,500 workers comp claims were filed. Many workers are also reporting that they are being fired or demoted because of this. The issue is significant enough to come to the attention of Congress.

Top workers comp drug problem - Joe Paduda at Managed care Matters discusses how Actiq is emerging as one of the most problematic drugs in workers comp. Actiq is a powerful pain narcotic that is used in cancer treatment, but has not been approved by the FDA for use with musculoskeletal injuries, yet it is one of the most frequently prescribed drugs in workers comp. Joe suggests that part of the reason for the increase is the inability of many physicians to adequately deal with pain.

Night workers at high risk - Diane Pfadenhauer of Strategic HR Lawyer features a post discussing the perils of the graveyard shift. According to a cited article, night workers are 20 percent more likely to have a work-related injury than day workers, and are also prone to higher rates of cancer, heart disease and gastrointestinal disorders.

State reform initiatives - In Ohio, labor groups that were seeking to overturn many of the reform provisions enacted last year failed to get enough signatures to get a ballot initiative in the upcoming election. In South Carolina, business leaders are pressing legislators to make workers compensation reform a priority in the next session. One of the key issues in that reform is the potential elimination of the state's second injury fund.

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September 27, 2006

 

Just in time for your lunchtime reading, a new issue of Health Wonk Review has been posted at The Century Foundation. Many thanks to Leif Wellington Haase for serving as our host. One of the big topics for discussion this week is a recently released health care study by the Commonwealth Fund.

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September 25, 2006

 

Is an injury that occurs as the result of a dive at a swimming hole a compensable injury? It is if swimming is one of the activities at a mandatory company-sponsored event. Roberto Ceniceros of Business Insurance alerted us to a recent ruling by the Arkansas Court of Appeals in the case of Tina Engle vs. Thompson Murray Inc. and Continental Casualty Co.. Ms. Engle was injured while diving at a company retreat, a team-building exercise. An administrative law judge had originally denied the claim, finding that the employee was not at work at the time of the injury. The Appeals court disagreed, finding in favor of the employee.

An article from the Arkansas News Bureau tells us that Ms. Engle had the responsibility of organizing the off-site company activity, which included pontoon boat rides and a place for employees to climb rock and jump into the water.

"The purpose of the off-site meeting was for employees to bond, refresh, set new goals and have fun," Crabtree wrote. "As long as the participants were advancing the purpose of the meeting, they were furthering the interest of their employer."
Crabtree said it "defies reason to assert that (Engle) was required by her employer to find a place from which to jump, but was not expected to participate in the jumping."
Engle "was engaging in conduct permitted and participated by the employer; therefore, it was erroneous for the commission to conclude that (Engle) was not engaged in employment services because the employer did not expressly direct (Engle) to jump from the cliff," Crabtree wrote."

This concept of advancing or furthering the interests of the employer is one that surfaces frequently as a determining factor whether an employee should be compensated for injuries that occur outside the normal place or time of work. Does the employer derive some benefit from the performance of the activity? What we refer to as "mandatory fun" - activities that an employer requires - are generally found compensable, even when they involve riding around in go-karts. If you don't want to own any resulting injuries, think twice about requiring the activity.

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September 21, 2006

 

The Insider has apparently underestimated the will and the wisdom (if not the wit) of the US House of Representatives. We thought they were incapable of confronting the crisis of 12 million undocumented workers. OK, we were wrong. Now that the House has voted to build a 700 mile wall along the Mexican border, we're on board. We're part of the team. And we have some suggestions for transforming this brilliant piece of legislation into a public sector bonanza.

Designing the Wall
In determining a design for the wall, we do not have to reinvent the proverbial wheel. After all, the Chinese built a splendid wall, beginning the work 200 years before the birth of Christ and completing it in the 1600s. As Richard Nixon observed when he visited that famous landmark: "It sure is a Great Wall." The Chinese wall is nearly 4,000 miles long; the Great American wall will be a puny 700 miles. How difficult could that be?

Now, cynics will point out that the Chinese wall did not really accomplish its goal - keeping out the nomadic tribes that periodically destroyed the great Chinese cities. The final invaders, the Manchus, convinced a guardian of the gate to open a door and they simply walked through. (No danger of that happening here. Our private sector guards will be impervious to bribes.) Legend has it that it took three days for the Manchu army to complete their passage through the gate. Once they took over China, the wall immediately became obsolete.
Important note: The Great Wall may have failed in its defense-of-China role, but today it is a great tourist attraction. If we play our cards right, we might have a Disney-esque Wonder of the World that will turn the barren borderlands of Texas and Arizona into a leading tourist destination!

As for the design itself, now that the Big Dig project has been completed in Boston (except for a few, ahem, modest repairs, where the tunnel roofs are collapsing), we have a pool of engineers willing to lend their expertise. If you can build a tunnel, heck, you can build a wall.

Constructing the Wall
After designing an impenetrable, weather-proof, permanent and aesthetically pleasing barrier, the next problem will be building it. Constructing a wall across the desert does raise some interesting challenges. The desert does not offer comfortable working conditions, the type favored by American labor. There may well be health issues, dealing with all that sand and wind (as in Iraq). The Chinese, of course, could conscript a virtually unlimited population to work on the wall. We don't have that option.

The labor problem, like the wall itself, is not insurmountable. We'll do what we did after the World Trade Center collapsed and after Katrina devastated the southern coastline. We'll build the wall...with undocumented laborers! We can pay them below market wages. We'll scimp on the benefits - they just send their earnings across the border to support their families anyway. And when they whine about working conditions and work-related injuries, we'll deny their claims.

Best of all, as soon as these illegal workers complete the job, we'll just escort them through the door to the other side of the wall. Sayonara, baby!

Paying for the Wall
The current budget for the project is about $7 billion. The original budget for the Big Dig was about $3 billion, but the final accounting came to $15 billion (and still counting). The Big Dig is the most expensive public works project in American history. Well, records are made to be broken. We can project the Great American Wall's ultimate cost to be something in the vicinity of $30 billion. It's a bargain!

Now if we can just figure out how to prevent those darn smugglers from using boats to drop people off along the thousands of miles of unguarded coastline. Hmm.


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September 20, 2006

 

In our three years of blogging, the Insider has developed a few persistent themes, one being the impact of an aging workforce on risk management. We know that older workers tend to work safer - they have lower frequency rates for injuries - but once injured, they are slower to recover. The older you are, the longer it takes to bounce back (we write from personal experience). We also know that older workers are more prone to shoulder injuries (one of the more expensive injuries in the comp system).

Given our premise that good management takes a proactive approach to any pending problems, we believe that managers have to plan for the inevitable transition to a younger workforce. Managers need to identify the older workers whose skills and experience are essential to the company's success and take steps to preserve their knowledge and experience. At the same time, managers must be alert to aging workers whose ability to perform the job is eroding. Good managers keep their eyes open. They are always alert. And they don't expect potential problems to solve themselves.

The Tennessee Valley Authority tackled the problem of knowledge retention in an interesting manner. Confronted with the retirement of skilled older workers and the need to train their young replacements, they came up with three simple questions for managers:

What knowledge is likely to be lost when particular employees leave? (the "What?")
What will be the business consequences of losing that knowledge? (the "So what?")
And what can be done to prevent or minimize the damage? (the "Now what?")

Get Talking
On the workers comp side, the challenges are a little different. Employers are worried about exposures that increase with age. At a workers comp seminar in the Lakes region of New Hampshire yesterday, company managers raised a number of questions relating to older workers:
- "We have a 73 year old maintenance man. Truly indespensible. He's just coming back from knee surgery. Should we take him back? Is our comp going to pay for the next surgery?"
- "We have a morbidly obese hairdresser, in her mid-60s. She has to stand to perform her job. If her knees or hips give out, will that be work related?"
- "I have a electrician who went out on comp for his right knee about two years ago. Now he's out for his left knee. The right knee is giving him trouble again. Do I take him back?"
- "I have an auto mechanic who is losing his eyesight. In a year or so, he'll be blind. What should I do?"

These are very difficult questions. The answers begin with a simple but not necessarily easy task: opening lines of communication with employees (and their doctors) in areas where communication has not existed in the past. When in doubt, talk it out. I've often found that workers whose skills are eroding, whose bodies are breaking down, respond with a sense of relief to have the issue out in the open. (To be sure, some are in complete denial, in which case you have to focus consistently on the specific job functions that are not being performed to company standards.) Ideally, managers should try to reach a mutual accommodation that satisfies all parties. It's not always possible, but it's surely the optimum goal.

For example, in the case of the mechanic losing his eyesight, the employer could help this person begin the transition to a sightless life. Help the worker access services for the visually impaired. Work closely with the treating physician on phasing out job responsibilities. Perhaps the worker could mentor a younger replacement. This worker is confronted with a life management situation for which he is not really prepared. The employer's good management skills, along with his sincere respect and concern for the worker, can help facilitate a successful transition.

When confronted with a challenge relating to an aging workforce, managers should keep in mind the process outlined by the TVA: identify the issues, explore the implications and then figure out what you can do about it. The what, the so what and the now what.

Let's Talk some More?
The challenges of an aging workforce are formidable. As is so often the case in the 21st century, we are dealing with unprecedented problems and issues. Just as we need to find ways to encourage a new dialogue between managers and aging workers, managers need to find ways to access the latest information. The Insider is participating in an "Aging Workforce Summit" in Chicago at the end of October. We think the summit offers a great opportunity to confront the full gamut of issues relating to older workers. We expect to learn a lot, even as we try to help managers answer the kinds of questions raised in the New Hampshire seminar.

Check out the conference website here. You'll find some interesting articles that carry the above discussion a little further.

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September 18, 2006

 

It's one of our nation's dirty little secrets: immigrant workers are doing some of the nation's most dangerous jobs, are being injured and dying disproportionately in those jobs, and denied benefits when injuries and deaths occur. In a political climate where where the rhetoric and emotions are high and seemingly getting higher by the day, a "blame the victim" mentality is pervasive.

Peter Rousmaniere of Working Immigrants point us to an important expose by Liz Chandler of McClatchy Newspapers on the widespread practice of denying workers compensation to illegal immigrant workers who suffer work-related injuries. It's a compelling read about how undocumented workers are now performing some of the most dangerous jobs in the U.S., and are frequently tossed aside by unscrupulous employers when injuries occur.

"From field hands to garment workers to poultry processors to construction crews, injuries abound in industries that rely on an estimated 7 million undocumented workers, often to do dirty and dangerous jobs. Yet those who are undocumented are frequently cheated out of benefits that American workers have taken for granted for nearly a century, a McClatchy Newspapers investigation has found.
Federal labor officials haven't studied whether undocumented workers are wrongfully being denied compensation. But the exploitation is rampant, according to interviews with scores of illegal workers, employers, workers' comp lawyers, health care providers and workplace experts, and a review of lawsuits and workers' comp claims.
In one national study, university researchers surveyed 2,660 day laborers, most of them working illegally. One in five said he'd suffered a work injury. Among those who were hurt in the last year, 54 percent said they didn't receive the medical care they needed, and only 6 percent got workers' comp benefits."

The courts have traditionally upheld worker rights in these matters and there are many good reasons beyond the mere moral imperative to do so. Regardless of immigration status, the employer enjoyed the benefits of the workers' labor, and has the commensurate responsibility to provide benefits for a worker injured on the job. If an employer has no financial responsibility for work injuries for one class of workers, that creates a powerful perverse incentive for unscrupulous employers to hire that class of worker for the riskiest jobs. Such unconscionable practises are also rewarded these employers with a financial advantage over honest competitors.

Failure to provide benefits also contributes to an erosion of exclusive remedy, the quid pro quo lynch pin upon which the very workers compensation system is founded: in exchange for providing medical care and temporary wage replacement to injured workers, employers are protected from potentially ruinous lawsuits.

Immigrant injuries and fatalities bucking the national trend
In recent years, while the total frequency of workplace injuries and fatalities has been declining across the nation, the numbers of deaths and injuries for immigrant and hispanic/latino workers have been climbing - as depicted in the graphic accompanying Chandler's article.

"Workplace safety programs also are failing these workers, as the number of inspections and the staffers to do them has declined. The nation's 2,300 inspectors check 1 percent of 7 million employers each year, and critics say fines are so low that risky operators consider them a cost of doing business."

There's much more in the article and the accompanying multi-media - we encourage you to read it for yourself. We applaud Chandler's attention to this important matter - it's one of the best treatments of the topic we've seen since the Palm Beach Post's 2003 series entitled Modern Day Slavery. For more on this topic, see these posts:

- Jobs that lure Mexican workers to the U.S. are killing them
- Hispanic Fatalities on the job: the Tip of the Iceberg
- S. Carolina to bar workers comp for undocumented immigrants?
- Janitors: The big squeeze
- Wyoming court to examine compensability for illegal immigrants
- California court upholds workers comp for undocumented workers
- Illegal Immigrants: Working In the Twilight Zone
- Day Labor: Undocumented, Unprotected, Unconscionable
- Immigration Policy: Cracking Down or Cracking Up?

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September 15, 2006

 

For a smorgasbord of posts covering risk, sample this week's edition of Cavalcade of Risk. Jay Norris does a fine job hosting - check out his blog, too - Colorado Health Insurance Insider.

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September 14, 2006

 

A recent ruling (PDF) by the U.S. Court of Appeals in the 6th Circuit confronts the issue of morbid obesity - specifically, whether individuals suffering from that condition are protected by the Americans with Disabilities Act (ADA).

Stephen Grindle was a driver and freight handler for Watkins Motor Lines. He weighed around 400 pounds. In December 1995, he was climbing a ladder, when a rung broke. (Hmm, potential liability issues here?) He suffered a knee injury. He continued working into January, when he requested time off to rehabilitate his knee. (We assume Grindle collected workers comp, although the court documents are silent on this.)

Following its own written policies, the company agreed to hold Grindle's position for up to 180 days. Just before that deadline was reached, Grindle produced a letter from his treating physician, releasing him for full duty. The employer balked, because the doctor had no specific knowledge of what the job required Grindle to do. The employer wrote to the doctor, seeking clarification. They never received a response.

So they sent Grindle to their own doctor. Dr. Laurence found that Grindle had a limited range of motion and was unable to safely perform the job. He also writes: "On physical examination, the most notable item is that the patient weighs 405 pounds." Most notable, indeed.

Having passed the 180 day mark, Watkins terminated Grindle.

Grindle filed a wrongful termination suit with the EEOC in September of 1998. Four years later, the case was dismissed under summary judgment in the employer's favor (the wheels of justice grind rather slowly...). Grindle appealed. More than 10 years after the incident, the 6th Circuit upheld the lower court ruling.

The Causes of Morbid Obesity
The court focused on two aspects of ADA eligibility: whether morbid obesity was inherently a disability; and whether the employer "regarded" Grindle as a disabled person. We should keep in mind the three causes for morbid obesity listed by the National Institutes for Health: overeating (well, duh!); thyroid disorders; and lack of physical activity (well, duh again). Other sources refer to a possible genetic component.

According to the court, morbid obesity is not inherently an ADA-eligible condition. Specifically, to be eligible under the ADA, there would have to be a physiological cause for the condition. If, for example, Grindle could point to a thyroid problem that caused his obesity, he might indeed be protected by the ADA. His employer would then have been obligated to "reasonably accommodate" him. Justice Gibbons, in her concurrence, added the following intriguing footnote to close out the case:

It is possible that morbid obesity is a disorder that by its very nature has a phsyiological cause. This would preclude the necessity for a plaintiff to put forth evidence that his individual case was caused physiologically. No court or agency has ever adopted this position, however, and the EEOC has put forth no evidence, medical or otherwise, to support such a sweeping conclusion.

Finally, the court did not find any discrimination in the way the employer viewed Grindle. Dr. Laurence's "most notable item" falls under the heading of "objective observation."

Lessons for Employers
The employer prevailed in this case because they kept their focus where it belongs: on the specific requirements of the job. The issue was not Grindle's morbid obesity, but rather his inability to perform the job's essential functions. He was simply unable to move around with ease, to bend, lift, twist and climb, as the job required him to do. It's interesting to note that the case may have hinged on what did not take place: in failing to respond to the employer's request for clarification, Grindle's own doctor dropped the proverbial ball. In doing so, he sealed Grindle's fate.

Ten long years after the rung on the ladder gave way, we learn that the employer acted in a reasonable manner. Grindle, at least in the view of the 6th Circuit, is not an individual with a disability, but simply an individual unable to perform the job.

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September 12, 2006

 

When it comes to workers comp reform, it's always a good idea to follow the money. Too often, reforms focus on dollars saved, as opposed to measuring the quality of services provided. Too often, reform comes at someone's expense: often conscientious medical providers, and almost always, injured workers. Here are a couple of recent examples:

Ohio: Managing Care or Managing Cash?
As part of the mid-1990 reforms, Ohio requires all employers to sign up with a managed care organization (MCO). This was supposed to privatize the handling of claims and lower costs. They did indeed privatize managed care, but as an article in the Cleveland Plain Dealer makes all too clear, they did not lower the costs. The paper estimates the cost of reform at $1.6 billion. In fact, since the MCO system began, the overall number of claims in Ohio fell 48 percent, but the annual cost to manage the system, including the MCO component, increased by $167 million. Even when you account for inflation, this is an increase of 30 percent. The costs per active claim increased from $442 to $914 in constant dollars.

This being Ohio, land of the infamous Thomas Noe (an Insider Frequent Flyer - just enter his name in the search engine to the right), don't blame us for jumping to certain conclusions: we suspect that the increase in costs have a direct relationship to increases in political contributions. The Ohio Bureau cut a sweetheart deal with CareWorks, the major MCO player in the state. CareWorks was given exclusive access to substantial discounts for inpatient hospital stays - discounts not available to the other MCO players. So CareWorks could squeeze the hospitals, offer discounts to their employer-clients, and still have enough left over to keep the politicians happy. The best of all possible worlds, unless you're a medical provider or an injured worker...

Our colleague Joe Paduda, who blogs at managed care matters, is quoted in the article. In typical Joe fashion, he sums up the Ohio system in one word: "unconscionable."

California Dreaming...or Nightmare?
The land of Arnold underwent some radical reforms a couple of years ago. The preliminary results look good. Costs to employers are down substantially (although nowhere near levels in neighboring states) and insurers are actually making money. Is it party time in tinsel town?

Not quite. We read in the LA Times that reforms have come at the expense of specific benefits. While California was never known for its generous payments to injured workers, the reforms drastically reduced permanent disability benefits. When you have Stanley Zax, President of Zenith National Insurance, the state's biggest private comp carrier, calling for a restoration of the benefits, you know you have a problem.

The article cites the example of a former star athlete who lost a leg in a construction accident. Under the old law, he would have received $122,812. Under the reforms, his benefit is less than $30,000, and the insurer has turned down his request for a prosthetic leg, rehabilitation training and physical therapy (all of which would increase the likelihood of his returning to productive work).

In the days prior to reform, the prime beneficiaries of California's whacked out system were unscrupulous doctors and attorneys. The crack down on their injury mills was long overdue. However, it's neither fair not prudent to make genuinely injured employees bear the brunt of reforms. In this particular case, the reforms appear to meet the Paduda standard: "unconscionable."

Benefits are Not the Problem
Over the past 15 years of comp reform, as you review the changing statutes from one state to the next, there is one common denominator: a reduction in benefits paid to injured workers. In Massachusetts, perhaps the most successful of all the reform projects, the state dropped from being the 3rd most expensive to an overall ranking around 45th. However, the average weekly wage benefit was reduced from two thirds to 60 percent. In retrospect, the reduction seems a bit gratuitous. The reforms would have been just as effective without this indemnity cut.

We're all for reform. But let's not balance the books on the backs of injured workers, who bear little, if any, responsibility for the comp crisis of the late 1980s. The best reforms create a fair and responsive system, with as little "friction" as possible. Reforms need to focus not just on medical rate schedules and insurer protocols, but on employers themselves, because without educated employers, the system cannot work effectively. Employers must respond to the injured employee in a supportive manner, document the incident, secure prompt treatment and speed recovery through the use of temporary modified duty. Employers are in a unique position to manage the recovery process. If they blow it, the tools of managed care, utilization review and good claims adjusting will not achieve the goal of reducing costs.

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September 11, 2006

 

The anniversary of 9/11 is a difficult one for many. The insurance industry was hit particularly hard, with the loss of hundreds of colleagues at Marsh, Aon, and other insurance-related companies housed in the World Trade Center. And here in the Boston area, many were affected by the loss of friends and neighbors traveling on the planes to New York. Few were left untouched - if not directly, then by six degrees of separation. A close friend lost a cousin; my next-door neighbor normally took Flight 11 to California for buying trips, but missed that day due to illness. Everyone around here has stories like that.

With the anniversary comes a barrage of heartbreaking stories about the ongoing stuggles that many survivors experience in picking up the pieces and moving on with their lives. Many of these people are suffering from debilitating post-traumatic stress disorder (PTSD).

After a traumatic event, many people suffer a temporary stress reaction that can last for weeks or months and be quite severe, but with support, most work through it and go on to recover. About one in five will go on to develop PTSD, a more severe, persistent, and incapacitating stress reaction. PTSD is often characterized by delayed onset, and often does not manifest itself until significantly after the event.

In addition, there is the sad ongoing saga of the emerging first responders' health crisis: nearly 70% are reported to have debilitating respiratory illnesses. We are only seeing the tip of the healthcare crisis iceberg here.

The insurance industry could perform a great service by tracking and conducting research on the prevalence of 9/11-related physical and psychological disabilities over time. Studying this event and Katrina could provide valuable clues to disability prevention and treatment in the aftermath of disasters.

This sad anniversary should be a reminder: Hug your loved ones every day. Be kind to your colleagues. Don't sweat the small stuff.

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September 8, 2006

 

Does an investment in mechanized patient lifting equipment pay for itself? Yes, according to a recent NIOSH study. In an article entitled Making the Case for a Safe Lifting Program in Nursing Homes, Josh Cable discusses the NIOSH study in Occupational Hazards. The agency's six-year study encompassed 1,728 nursing personnel at six nursing homes ranging in size from 60 to 120 beds. Each of these facilities used mechanical lifting equipment and re-positioning aids, trained workers, and implemented a zero-lift policy. Among the results:

"The initial investment of $158,556 for lifting equipment and worker training was recovered in less than three years based on post-intervention savings of $55,000 annually in workers' compensation costs," the authors concluded.
Other quantifiable improvements in worker safety, according to NIOSH, included a 61 percent reduction in resident-handling workers' compensation injury rates; a 66 percent drop in lost workday rates; and a 38 percent decline in restricted workdays.
Also, the rate of post-intervention assaults during resident transfers was down 72 percent based on workers' compensation claims, 50 percent based on OSHA 200 Logs and 30 percent based on first reports of injury data.

No doubt about it, these numbers are impressive. But aren't patient handling injuries a problem that proper training in safe lifting and body mechanics can prevent? According to NIOSH, training alone is ineffective as a prevention strategy because "lifting the weight of adult patients is intrinsically unsafe." It's also important to note that the equipment alone won't do it - workers also need to be trained how to use the equipment, and management must implement and enforce a "zero lifting" policy.

For more information, see Safe Lifting and Movement of Nursing Home Residents from NIOSH. Also, see our previous post, Washington passes "Safe Patient Handling" legislation.

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September 7, 2006

 

Our pal Hank Stern at InsureBlog is hosting Health Wonk Review #15. It's a robust edition, and it is served with a special side order, Hank's secret sauce. Be there or be square!

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September 5, 2006

 

In the never-ending conundrum of undocumented workers, the solution appears to be no solution. With the President backing away from his middle-of-the-road stance, the New York Times reports that the Republicans are about to give up on a legislative solution to the problem of illegal immigration. The immigration bill, recently a high priority of the administration, is about to slip quietly off the table.

This comes as no surprise. In our blogs over the past few months, we have looked for the legislative thread, the core beliefs around which a bill could be fashioned. But a bill requires a middle ground, and in this case, there simply isn't any. On one side, you have 12 million or so undocumented workers who are indeed working. Thousands more slip through our porous borders every month. So one brand of realist says, let's seal up the borders and deal with the millions already here. Legitimize people who have established themselves in the economy and send the rest home. This solution would dramatically raise the cost of living for everyone.

On the other side, you have another kind of realist. These folks are here illegally, so they are not due any consideration. Round them up - all 12 million - and toss them out. Let them reapply and re-enter legally. This solution would rip apart communities and tear the heart out of an essential part of our workforce.

Where is the middle ground? Like so many other public policies of late, this one is built on the San Andreas fault. The earth is shifting and the middle ground is turning into a void. You can't afford to legitimize millions of undocumented people - and if you did so, you send the wrong message to those who came to our shores legally. There is no practical way to seal up the borders. And there's surely no way you can toss them all out.

The Status Quo
Here's the Insider prediction: enforcement efforts are going to become much more visible. A few thousand undocumented workers will be locked up and, eventually, tossed out. But these efforts are not intended to confront the real problem. The arrests are just symbolic. The vast majority of illegals will continue to do what they always do: work hard at tough jobs and send as much money home as possible. States will continue to struggle with the status of these disenfranchised workers. We'll sort of pretend they aren't there. They will continue to work in largely substandard conditions, with few benefits. When they are seriously injured on the job, we'll make sure they collect their workers comp benefits.

It's hard to imagine congress coming up with a solution. There's a significant downside to every legal remedy. If your goal is to avoid rocking the economy, you leave these folks right where they are, working in marginal conditions for marginal wages. That way, we can have our lawns mowed, our groceries bagged, our apartments built, our houses and hospitals cleaned and our crops harvested, without significantly raising the cost of doing business. We all benefit from the status quo, so it's in our collective interest to keep it going. To be sure, it isn't really fair. It isn't exactly right. But, heck, we didn't ask these folks to come here and, despite some inflammatory rhetoric, we don't want them to leave.

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September 1, 2006

 

In all the long weekend holiday plans and back-to-school activities, the true meaning and the origin of Labor Day can be lost in the shuffle. The holiday celebrated on the first Monday in September "... is a creation of the labor movement and is dedicated to the social and economic achievements of American workers. It constitutes a yearly national tribute to the contributions workers have made to the strength, prosperity, and well-being of our country." You can read more about the struggles and history that led to the first Labor Day at the Department of Labor site.

What's the pulse of the American worker today as we head into Labor Day? The New York Times reports that three polls find workers sensing deep pessimism. Most survey respondents indicated that wages are not keeping up with inflation and that conditions are worse than they were a generation ago.

"The nonpartisan Pew center, said, “The public thinks that workers were better off a generation ago than they are now on every key dimension of worker life — be it wages, benefits, retirement plans, on-the-job stress, the loyalty they are shown by employers or the need to regularly upgrade work skills.”
In a poll of 803 registered voters commissioned by the A.F.L.-C.I.O., Peter D. Hart Research found that 55 percent said their incomes were not keeping up with inflation, 33 percent said their incomes were keeping even and 9 percent said their incomes were outpacing inflation."

With jobs being offshored, outsourced, and downsized, and with technology changing the very nature of how and where we work, it is an unsettling time for many.

Between now and Monday, there may not be a lot employers can do to tackle that deep-seated pessimism, but we think there are some simple things that employers can do to commemorate the holiday, even with the day fast upon us: recommit to providing a safe workplace. Take the time to thank your employees and let them know you value them. We think Labor Day might be a good time of year to issue bonuses, raises, and recognition programs.

A look back - tributes to the American worker
To commemorate Labor Day in the true spirit in which it was meant, we've gathered some links to a variety of sites that pay tribute to the American worker.

Labor Arts - a virtual museum that gathers, identifies, and displays historic images of working people and their organizations. The site states that its mission is "to present powerful images that help us understand the past and present lives of working people."

The Quiet Sickness is a dramatic photo essay by Earl Dotter chronicling hazardous work in America.

Lost Labor - Images of Vanished American Workers 1900-1980 - a selection of 155 photographs excerpted from a collection of more than 1100 company histories, pamphlets, and technical brochures documenting America's business and corporate industrial history.

Austin at Work is a fascinating site that uses historic images to show the changing nature of work over the ages.

Public History Resource center - "From the family in a tenement toiling over piecework to the farmer caring for his crops to the white collar crowds jamming the subway, the images, both textual and visual, and the experiences of work, both paid and unpaid, pervade the human experience and thus our history as well." This page features links to other sites that tell the story of the American worker.

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