February 2011 Archives

February 28, 2011

 

We have been following the sad saga of Joseph Casias, a former Walmart employee in Battle Creek, Michigan. Casias, 29, suffers from a sinus cancer and an inoperable brain tumor. (He looks so much older than his years.) After 5 unusually successful years as a Walmart employee, he injured his knee on the job, after which he underwent a mandatory drug test. Casias has a prescription for medical marijuana (legal in Michigan). Inevitably, he failed the drug test. Walmart fired him.

He sued for wrongful termination in federal court. He lost.

Judge Robert Jonker found that while Casias's use of marijuana was legal, Walmart was within its rights to terminate him. Nothing in the Michigan statute legalizing pot regulates private employment. As we pointed out in a recent blog, the issue of legal drugs in the workplace is a gray zone of formidable dimensions. Employers will usually err on the side of caution, as the exposures for negligent retention appear to outweigh the pressure to accommodate disabled employees. Hence, Walmart wins.

What is lost in the standard personnel procedures that identified Casias as a (legal) drug user and terminated his employment is a simple fact that may or may not concern Walmart. Casias was a highly motivated and valued employee. His work was exemplary. Workers like Casias are not easy to find, especially when the pay is marginal. It's worth a little extra effort to hold on to them. By following their own rules to the letter, Walmart wins in court but loses on the selling floor.

Legally Disemployed
Even though states are showing some flexibility in their approaches to marijuana, legalization is no help to workers who have a prescription for the drug. These folks will routinely fail post-accident drug tests. As a result, any injury to a worker using medical marijuana will result in a termination. Zero tolerance, zero employment.

We are not suggesting that states attempt to preempt the rights of employers in statutes that legalize marijuana. With so much at stake, with so many complex risk factors at play, employers must have the final say in who works and who is let go. We can only hope that employers use their powers - dare I say it? - compassionately.

Did Walmart have an alternative? With his serious illness, Joseph Casias appears to meet the ADA's definition of disabled. Walmart could have approached the dilemma through the ADA accommodation process. After Casias failed the drug test, they could have determined: first, that the drug was prescribed; second, that the drug use was not a factor in his injury; and third, that there have been no indications that his drug use has impacted his performance on the job. Having passed this three-pronged test, Walmart could have decided to "accommodate" Casias's disability by waiving the drug test results and retaining him as an employee.

Alas, in the world of huge corporations, the fate of one man just isn't worth that much effort. Why bother being flexible when it's so much easier - and perfectly legal - to show employees the door?

You know the Walmart motto: Save money. Live better. Nothing in there about doing the right thing for the likes of Joe Casias.

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February 24, 2011

 

Amid much controversy, the Texas Legislature is considering SB354, a bill that would allow licensed students and professors to carry concealed handguns on college campuses. The bill has passed a Senate committee and has been referred to the Committee of Criminal Justice, where it will be up for a hearing. (Follow SB354). With support from Governor Rick Perry and more than half the members of the House signing on as co-authors, most observers think that the bill will be passed. But according to an article by Patrick Williams in the Dallas Observer, concealed guns on campus is not necessarily a fait accompli: "[Similar] legislation has failed 43 times in 23 states since Virginia Tech," Malte says, referring to the 2007 campus mass murder that claimed 32 lives. "Every time somebody said this is a done deal over the last three years, it was defeated."

Utah is currently the only state that allows guns on campus, but legislation is on the docket in several other states. Fox Business News reports that eight other states currently have campus carry legislation underway. These include Arizona, Florida, Michigan, Mississippi, Oklahoma, Nebraska, New Mexico, and Tennessee.

With sympathetic Republicans at or approaching supermajority status in a few of these states, the political stars are in alignment for success. Ultimately, the deciding factor may come down to the strength of student and parental support or opposition. Keep Guns Off Campus says that the American Association of State Colleges and Universities (AASCU) and 271 colleges and universities in 36 states - 189 four-year colleges and universities and 82 community colleges and technical schools - have joined the Campaign to Keep Guns Off Campus. (See Listing). On the other hand,
Students for Concealed Carry on Campus point to widespread support - not the least of which is the mighty power and deep pockets of the NRA.

Follow-on to "Guns at Work"

The spate of campus carry legislation is a natural adjunct to the NRA's major "guns at work" legislative initiative, which has been sweeping the country in recent years to considerable success. According to the NRA, there are now 13 states that have laws permitting employees to have guns at work: Alaska, Arizona, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Minnesota, Mississippi, Oklahoma, and Utah. While the particulars of these laws vary, such laws generally allow licensed gun owners to keep guns locked in their cars at work, including on employer-owned parking lots. In some states, certain business such as hospitals, schools and prisons are exempt. This is an issue that has pitted the rights of an employer to establish policy for their private property (employer-owned parking lots) against second amendment rights. It's an issue that has been opposed by employer groups and associations.

For more history on the Guns at Work issue, see prior postings on the topic below.
Three new state laws limit employer restrictions on guns at work
Guns at work: coming to a neighborhood near you?
Workers with guns
Guns at work

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February 21, 2011

 

Dr. Trang Nguyen has some serious doubts about the effectiveness of spinal fusions, especially in workers comp. In his study of 1,450 cases of chronic lower back pain in the Ohio comp system, Dr. Nguyen focused on an outcome near and dear to the hearts of all comp practitioners: the number of injured workers returning to the workplace after surgery. The results of his compelling (if less than purely scientific) study, published in Spine Magazine, are cause for alarm.

Dr. Nugyen looked at cases involving chronic back pain that were at least two years old, divided equally among workers who had spinal fusions and those who did not. Among those with fusions, only 25% returned to work, compared to 66% among those who received conservative (non-invasive) treatment such as physical therapy.

That is a huge differential. In addition, 27% of the fused workers had to undergo a second surgery, and as any claims adjuster can tell you, doubling up on spinal surgery places workers on a downward slope toward failed back syndrome: permanent total disability. Among the fused workers, 11% were permanently disabled, compared to only 2% among those who avoided surgery. Finally, most of the workers who underwent fusions were still on strong opiates two years after the treatment. In other words, they still suffered from the pain that led them to treatment in the first place.

While this is not a definitive study, the findings surely offer a cautionary tale not only for workers who suffer from back pain, but for their families and employers as well. It is no great mystery why fusions have become the treatment of preference for so many medical specialists. One doctor used the analogy of giving out hammers: people with hammers - surgeons who can do fusions - look for nails (people who might need the treatment).

Something for the Pain
We are an impatient culture. When in pain, we want immediate relief. Given time, appropriate medications and the skilled hands of physical therapists and chiropractors, the pain usually goes away, or at least reaches more tolerable levels. To be sure, there are severe injuries when fusion is the necessary option; however, pain alone is not an indicator of such severity. The problem with fusion is that it creates rigidity in a part of the body that is designed for flexibility. A rigid spine is an open invitation to lifelong pain and despair.

From the comp perspective, we should remain aggressively sceptical of most proposed spinal fusions. Claims adjusters should routinely require a disciplined utilization review, an objective second opinion and an independent medical exam. Place a strong burden of proof on any doctor proposing fusion for an injured worker. Fusion should be the treatment of last resort.

These are not merely delaying tactics. Rather, they are essential strategies for buying precious time, time for the natural healing process to take place and time to avoid what often becomes a path to oblivion. If, as this study shows, the odds for return to work are more than double for workers receiving conservative treatment, then it is in everyone's best interest to avoid fusion surgery. Refuse to Fuse. That's a motto worth posting over the desk of every comp adjuster in America.


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February 17, 2011

 

When is healthcare like a box of chocolates? Find out over at Colorado Long Term Care Insider, where Louise & Jay Norris host an excellent Valentine's Week Edition of Health Wonk Review.

Other news of note:
Tasers & cop claims - Roberto Ceniceros of Comp Time has an interesting post on how taser use by police is reducing injury rates and comp claims because it provides a low-impact way to subdue suspects. But tasers are also used on cops-in-training, sometimes resulting in serious injuries.

The straight dope - Joe Paduda has a do-not-miss post on narcotic opioids in workers comp and Cephalon's role, in which he discusses how drugs like Fentora & Actiq, which are FDA approved only for cancer patients, are being promoted to workers comp patients. (One court ruling stated, "data suggested that more than 80% of patients using Actiq did not have cancer," and "oncologists accounted for only 1% of Actiq prescriptions filled at retail pharmacies in the U.S.") Cost is a huge issue, but Joe points out that it is not all about the money: Actiq has been linked to dozens of deaths from overdose.

Medical marijuana - Last week, Michigan court rulings dealt a double blow to medical marijuana. One of the Michigan rulings upheld the firing of a Walmart employee who had been proscribed the drug to control symptoms of his brain cancer, a case we posted about last year: Walmart: Shopping for Souls in Aisle Three. (Also see our recent post: Medical Marijuana in the Workplace: Dude, Lock Me Out!.)

Insurer market share - Cyril Tuohy of Risk & Insurance offers a short journey through the latest insurance industry statistics, including some great stats about market share: This Just in: Known and Lesser Known Facts About the Industry

Not something you see every day - CompNewsNetwork informs us that the Ohio Bureau of Workers' Compensation has recently snagged a record $830,000 in restitution from a prior fraud conviction. The case was truly egregious - an anesthesiologist who bilked the system for $60 million in fraudulent claims - while contributing to at least two deaths in the process. Dr. Jorge Martinez was sentenced to life in prison for "the first known conviction involving a criminal charge of health care fraud resulting in death after the overdose of two patients seeking treatment for work related injuries."

Illegal immigrant update - Peter Rousmaniere's Working Immigrants blog is your in-the-know source for tracking the latest issues and stats on the topic. Via the Pew Hispanic Center, he informs us that the 2010 illegal population in 2010 remains about the same as in 2009: about 11.2 million, of which 8 million are in the workforce, and 58% of which are Mexicans. See more detail: Estimate of illegal immigrant population in 2010.

Good WC bookmark - We are adding WorkCompWire as a bookmark in our sidebar and you should keep it handy too. It's a good source of news and opinion - check it out!

Savings on complex care - Yvonne Guilbert points out that overlooking simple facts can add significant costs to a claim very quickly. She asks carriers what they are missing on complex claims that might be costing them money.

Market pulse - At PropertyCasualty360, Caroline McDonald talks about why buyers shouldn't get too comfortable with low workers comp rates. One of the primary sources for the article is our friend Mark Walls of Safety National - who is also well know as the founder of LinkedIn's Work Comp Analysis Group.

Diversity - Jared wade posts that 18 insurance firms are among the best companies for LGBT employees to work for - "scoring a perfect 100% as a Best Place to Work for their 'support equality for lesbian, gay, bisexual and transgender employees,' according to HRC."

Distracted driving in NY - A sign of things to come? In New York, drivers will get two points for talking on hand-held cell phones. A two-point penalty has already been in place for texting while driving. At that rate, auto insurance sure could get expensive quickly for compulsive phone-o-philes.

Mental health - CCOHS, the Canadian counterpart of OSHA, makes the case for why employers should care about mental health at work.

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February 16, 2011

 

A Purdue University report revealed that 2010 was the deadliest year in decades for grain bin fatalities. According to a Bloomberg story by Michael J. Crumb, the report indicated there were "51 grain bin accidents last year, up from 38 in 2009 and the most since tracking began in 1978. Twenty-five people died, and five of them were children under age 16. The previous record for grain bin accidents was 42 in 1993."

The bulk of these fatalities occurred in major corn and soybean growing states: "Illinois led the country with 10 accidents last year, followed by Minnesota with eight. Wisconsin had seven, and five were reported in Iowa." The reasons for the spike were attributed to an increase in corn production due to ethanol demands and an unusually wet season. Moisture in storage facilities can cause spoilage and rot, resulting in caked grain which gets clogged and the grain does not flow freely out of the bin so workers enter the bins to dislodge clogs. Of course, the primary reason for the spike in fatalities was the failure to adhere to safe handling practices. As with many industries, unsafe practices are often defended as being "the way it's always been done."

The US Department of Labor and OSHA recently cited 2 Illinois grain elevator operators and imposed nearly $1.4 million in fines for 3 fatalities in incidents where workers suffocated after being engulfed in grain. The citations were issued to Haasbach LLC in Mount Carroll and Hillsdale Elevator Co. in Geneseo and Annawan, Ill., for willful safety violations and to Haasbach for child labor violations. The OSHA link enumerates the nature of the violations in some detail.

Last summer we posted about two of these fatal accidents:
After 2 teen deaths, OSHA puts grain handling facilities on notice
Two farmworking teens killed in silo; media is mystified

OSHA issues letters, guidance to grain bin operators
In response to these incidents, OSHA issued letters to 3,000 grain bin operators. More recently, they issued a second batch of letters, this time to 10,000 grain bin operators across the U.S.

OSHA's grain handling facilities standard includes a requirement that employers provide workers entering bins or tanks with appropriate personal protective equipment such as full body harnesses for easier removal in the event of an emergency. Providing proper protection and not allowing workers to walk or stand in products piled higher than the waist reduces the risk of workers sinking and suffocating.

OSHA also outlined the following guidance:

When workers enter storage bins, employers must (among other things):
1. Turn off and lock out all powered equipment associated with the bin, including augers used to help move the grain, so that the grain is not being emptied or moving out or into the bin. Standing on moving grain is deadly; the grain acts like 'quicksand' and can bury a worker in seconds. Moving grain out of a bin while a worker is in the bin creates a suction that can pull the workers into the grain in seconds.
2. Prohibit walking down grain and similar practices where an employee walks on grain to make it flow.
3. Provide all employees a body harness with a lifeline, or a boatswains chair, and ensure that it is secured prior to the employee entering the bin.
4. Provide an observer stationed outside the bin or silo being entered by an employee. Ensure the observer is equipped to provide assistance and that their only task is to continuously track the employee in the bin
5. Prohibit workers from entry into bins or silos underneath a bridging condition, or where a build-up of grain products on the sides could fall and bury them.
6. Test the air within a bin or silo prior to entry for the presence of combustible and toxic gases, and to determine if there is sufficient oxygen.
7. Ensure a permit is issued for each instance a worker enters a bin or silo, certifying that the precautions listed above have been implemented.

Additional Resources
Grain Handling
OSHA's Grain Handling Facilities Standard
Worker Entry into Grain Storage Bins
OSHA Agricultural Operations
Grain Handling / Harvesting Storage
Hazards Associated with Grain Storage and Handling
Confined Space hazards a threat to farmers
Dangerous Gases and Fires Can Make Silos Death Traps


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February 14, 2011

 

If Missouri is the "Show me" state, Pennsylvania is in the running for the "show me the documents" state. They have a way of over-engineering solutions to what may or may not be problems. (See our prior post ["Blood on the Forms"] on requiring injured workers to sign 2 forms at the time of injury.) Now the Keystone state weighs in on the independent contractor conundrum through the recently implemented Construction Workplace Misclassification Act, also known as Act 72.

In tackling the problem of misclassification, Pennsylvania has done something smart: they have limited the scope of the law to the construction industry, where the worst abuses abide. (Massachusetts kicked a hornets nest with an expansive definition of independent contractor that extends well beyond construction.) The statute contains the usual and customary language requiring independent contractors to control the work, work for others and provide their own tools. But in its relentless need for documentation, Pennsylvania requires general contractors and subs to get out the pens and archive some paper. Independent contractors must:
- Have a written contract for every job
- Carry at least $50,000 in general liability coverage for the duration of the job (this requires a certificate of insurance from the agent)
- Document a proprietary interest in their business (how would a sole proprietor do this - tax forms?)
- Realize a profit or suffer a loss for the project (an interesting and potentially problemmatic issue for craftsmen whose spouses are not accountants)

Act 72 prohibits general contractors from forcing subs to sign any contract that results in misclassification. It also forbids retaliation against any person who files a complaint under the law.

The Amish Exception
As we pointed out in a previous blog, Pennsylvania's Amish population (roughly 51,000 total) is generally exempt from insurance requirements. Amish employers are not required to provide social security or workers compensation coverage, and it appears likely that the Amish will be exempt from the new health insurance standards. When a need arises, they pass the (rather old fashioned) hat throughout their community.

So what happens when an Amish (or non-Amish) general contractor hires an Amish sub? Which of Act 72's requirements apply to the Amish? Certainly not the general liability insurance. Perhaps not the "profit and loss" and "proprietary interest" documentation. While we are not suggesting that employers seek out Amish subs to avoid Act 72, it might simplify matters. For everyone else in PA, it's time to focus on the paperwork.

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February 9, 2011

 

Feeling risky? Catch up on your reading - Jaan Sidorov of The Disease Management Care Blog hosts this week's risky roundup: The 124th Cavalcade of Risk

Work Comp history
Yesterday, we posted a feature on window washers as a dangerous profession, which included some vintage photos of workers pre-OSHA. Later, via Complex Care Blog, we were alerted to Peter Rousmaniere's excellent article in Risk & Insurance, Into the Work Killing Ground, which turned the clock back even further. Peter offers a fascinating and chilling glimpse into what the working world was like at the start of the last century, before workers compensation laws had been enacted. He notes that, "The fatality rate at the time, if transposed to today's population, would exceed 300,000 deaths a year. Our rate was twice as high as England's." He talks about one young attorney, Crystal Eastman, who began documenting injuries and fatalities just in the Pittsburgh area alone. Her report became a catalyst for the ensuing law. If, like me, you didn't know about her contribution to workers' comp, you can learn more about Crystal Eastman at Wikipedia.

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February 8, 2011

 

Lunch-atop-a-skyscraper-c1932.jpg

Image from Wikipedia

Master Cleaners Ltd a central London cleaning company, has posted a fascinating photo feature on their blog called The World's Most Fearless Cleaners. We issue a vertigo warning in advance. Also, the caveat that we are not endorsing the safety procedures or lack thereof that are depicted in the photos.

Here are a few more detailed stories associated with the above photos:


We also recommend this dramatic photo gallery from the New York Public Library's digital archive of Empire State Building construction workers. There are few belts, lifelines, or tethers in sight so it is rather surprising that only five workers were killed during construction. We also found a rare video clip of 1940s-era window washers working on the Empire State Building. (With a bonus of some acrobats doing a stomach-churning stunt on the ledge) And here is a vintage 1934 feature on skyscraper window washers from Modern Mechanix.

Two years ago this month, we wrote about miracle survivor Alcides Moreno, a window washer who survived a 47 story plunge. In that post, we cited the ever-fascinating Free Fall Research Page, which documents reports, stories, and personal accounts of people who survived falls from extreme heights.

If tall structures are your thing, you might enjoy this skyscraper site which tracks the world's tallest buildings. This thread in Skyscraper City features a few articles about cleaning skyscraper windows.

Related resources
OSHA Fall Protection
OSHA: Scaffolding
No such thing as a free fall


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February 7, 2011

 

We have been tracking the hazardous effort to integrate medical marijuana into the workplace. It's not an easy fit. The burden falls on legislators, who write the laws, and on judges, who interpret these laws. The testing ground is often California, where fantasy and reality are so intertwined, it's getting more and more difficult to separate them.

We read in WorkCompCentral (subscription required) that a state senator named Mark Leno (any relation to Jay?) has introduced a bill to clarify the rights of medical marijuana users in the workplace. Senate Bill 129 gives workers a right to "damages, injunctive relief, reasonable attorney's fees and costs..." if employment decisions are based upon their medical use of marijuana. Then Governor Schwarzenegger vetoed the bill in 2008. Senator Leno is guessing he might have better luck with Governor Brown (AKA Governor Moonbeam).

Joe Elford, chief counsel for Americans for Safe Access, believes that legislation in necessary in order to assure equal rights for medical marijuana users who are not technically disabled: employers have an obligation to accommodate the disabled, but they may not view others the same way. "Under SB 129 you don't have to be disabled, you simply have to be a medical marijuana patient."

He goes on to say that Proposition 215 was not intended just for the unemployed: its protections must include workers in the workplace.

Ah, there's the rub. How do you draw the line between drug free workplaces and medically approved use of marijuana (and, for that matter, opiates and other pain killers)?

Locked Out, Tagged Out, Zoned Out
SB 129 tries to have it both ways. On the one hand, it states: "Nothing in this article shall require any accommodation of any medical use of marijuana on the property or premises of any place of employment or during the hours of employment." Any employee who is under the influence of marijuana at work can be terminated.

On the other hand, the bill tries to protect the rights of at least some employees at work who might in fact be somewhat impaired by their use of pot. While the bill does not provide protection for workers in "safety sensitive" positions, it does protect everyone else. It defines "safety sensitive" as "a job that has greater than normal level of trust, responsibility for or impact on the health and safety of others or where errors in judgment, inattentiveness or diminished coordination could put others in danger."

Hmm, what have these guys been smoking? How many jobs can you think of where "errors in judgment, inattentiveness or diminished coordination" would not be a serious if not immediate problem? Would this legislation actually protect employers from "negligent retention" claims where their (somewhat) stoned workers make marijuana-induced mistakes? "Sure, he messed up the calculation of your benefits. But you'll have to cut him some slack. He was on (medically approved) medication."

I have the greatest sympathy for legislators struggling to balance the rights of workers in need of specific medications with the rights of everyone else. But in this case, they appear to be straddling the Grand Canyon. Is there any job where inattentiveness and diminished coordination would be acceptable? Consulting? Actuaries? (just kidding). I would suggest that the legislators create a specific list of any such jobs. That would make for interesting hearings, at the very least, and the applications for these positions would increase exponentially.

You have a problem with how I'm doing my job? Dude, I'm locked out. Try me a little later.

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February 3, 2011

 

This dramatic satellite shot from NOAA captures the scope of the blizzard that swept across the country in the last few days. Being snowbound offered our contributing bloggers lots of time to think about all things healthcare, and in that arena, the climate is almost as stormy as the weather. The Florida judge's ruling against the Health Care Act was much on the mind of several of our bloggers, as was the State of the Union address -- both of which occurred since our last compilation. We have a lot of good submissions this week - grab a cup of cocoa to take the chill off and dig in.

Managed Care Matters - Hosting has its privileges, so we kick off this issue with a nod to the blogger who did the heavy lifting last issue, Joe Paduda. One thing we love about Joe is that he is never one to mince words, as evident in this week's submission, Paul Ryan's blatant hypocrisy - and the abject failure of mainstream media. Joe takes the Wisconsin representative to task, along with most of his colleagues in the GOP and the mainstream media. He finds today's hand-wringing over healthcare related debt insincere from the same players who ignored yesterday's elephant in the room. Also see his related post: If health reform is overturned.

The Apothecary (posted at Forbes) - Avik Roy's post Florida v. HHS: Why Vinson's Ruling Might Stand offers a detailed discussion of the four components of Judge Vinson's Monday ruling, with an emphasis on why the lack of a severability clause might be the key factor in overturning the entire law.

California Healthline - With talk of rolling back the Patient Protection and Affordable Care Act dominating the news, Dan Diamond reminds us that this isn't the first time that Congress has considered overturning a major health law. He wonders if the battle over the 1988 Medicare Catastrophic Coverage Act and its repeal 17 months later mightn't hold some lessons for today.

Colorado Health Insurance Insider - Louise Norris suggests that any debate on healthcare should be based first and foremost on facts rather than rumors. She puts on her detective hat in considering whether a Colorado Representative's vote was swayed by debunked info from an E-mail forward. She thinks the public debate should be informed by a higher standard and offers some clues for spotting suspect chain-mail claims

Disease Management Care Blog - Jaan Sidorov considers Atul Gawande's recent essay The Hot Spotters and asks if targeted care management is something new? Jann says that while The New Yorker article might garner the glitteratis' attention, the practice of identifying and reaching out to patients at risk is a standard MO in many commercial insurance plans. "What's next, Dr. Gawande," he asks, "discovering that there are machines that use electromagnetic radiation to take pictures of people's insides?"

Health Affairs Blog -Tim Jost offers an analysis of Judge Vinson's decision invalidating the Affordable Care Act, while his co-bloggers opine about the implications of the Sate of the Union speech and its aftermath: Kavita Patel on health care and the State Of The Union; Len Nichols who suggests being honest for a change, and Joe Antos with a taste of budgets to come.

Health AGEnda - In his post on the the John A. Hartford Foundation's blog, Chris Langston poses a good question: Why are Medicare's innovations more secret than the Joint Strike Fighter?. He champions the idea that we should be more nimble, transparent and collaborative in sharing innovations and improvements in care, particularly in terms of knowledge that we as taxpayers have already purchased.

Health Beat Blog - Maggie Mahar suggests that when it comes to electronic health records, perhaps we should walk before we run. She likens the mad stampede of EHR implementation to a market bubble with too many sellers, too many buyers, and too little information. In light of this, she tackles the question of whether Congress should defund the conversion to EHRs as some are proposing.

Health Business Blog - What makes you sad? For David Williams, it comes down to three words: US biogenerics policy. David makes the case that the debate on biogenerics misses the point: There are better, safer, faster ways to bring down the cost of biotech drugs while preserving incentives for innovation.

Health Care Renewal - Roy Poses makes a strong contribution to this week's roundup with his post Big Door Keeps On Turning. He lists examples of health care leaders going from government to industry and then back to government again. He asks if this revolving door, with its constant interchange among corporate and government health care leaders, is a sign of how corporatist health care has become and if we can we really expect a cozy corporate leadership class with no fixed loyalty to any organization to put the care of individuals and populations ahead of their personal interests and relationships?

Health News Review Blog - Gary Schwitzer enlists the help of Harry Demonaco, director of the Mass. General Hospital's Innovation Support Center in turning a critical eye on health screening advice issued by Prevention magazine, which advised readers, "If you haven't had these cutting-edge screenings, put this magazine down and call your doctor. Now." This is cited as another bad example of screening madness in US health care journalism, which promotes and fosters screening outside the boundaries of the best evidence.

Healthcare Economist - Jason Shafrin informs us that home health services are among the fastest growing services that Medicare provides. In thinking of reform to control this rise in spending, he turns to MedPAC's 2011 Home Health Reform Recommendations.

Healthcare Technology News - Rich Elmore and Paul Tuten discuss the launch of pilot projects enabling secure direct messages among healthcare stakeholders in their post about Direct Project implementations taking flight. They offer project details and note that this is a very big deal, as reflected in the related briefing by David Blumenthal (National Coordinator for Health IT), Aneesh Chopra (US CTO) and Glen Tullman (CEO Allscripts) among other federal and industry participants.

healthyimagination - In December, scientists and healthcare professionals shared groundbreaking research an NIH symposium focused on health disparities. Lisa Cappelloni shares some of the novel approaches aimed at eliminating health inequities in her post Advancing Minority Health: New Minds, New Methods.

The Hospitalist Leader - Bradley Flansbaum offers A Hospitalist's Lament, a thoughtful essay on the issue of end of life care and advance directives. In the light of controversies like death panels and care rationing, he states that our country may be at least a decade or two away from having a sophisticated discussion on this subject. He illustrates the complexity of the surrounding issues through an intriguing exercise conducted with his colleagues.

Improving Population Health - David Kindig is another contributor who listened closely to the State of the Union address, and asks if one could find any mention of population health, public health, or prevention in the speech. While he didn't hear those phrases directly, he was heartened by the speech addressing two major drivers of health -- education and jobs.

The Incidental Economist - Austin Frakt says that cost shifting is not well understood and has become a political football. He sheds light on the topic in the first of a series of posts: Hospital cost shifting: Brief history and possible future.

Insure Blog - As the oft-quoted Andy Warhol line goes, we will all have our 15 minutes of fame. But in the world of insurance, fame may be measured in cents rather than minutes, if Hank Stern's post about Ceridian's 2-cent Moment is any measure. In this case, the company made headlines when a cancer patient was denied coverage over a 2 cent shortchange. Or was there more to this story than the headlines? Hank digs a little deeper and offers his two cents on the matter. (Oh, and kudos to Hank & crew for Insure Blog's 6 year blogiversary - quite the landmark!)

John Goodman's Health Policy Blog - In his post The Case For Health Insurance, John states that everyone should have access to health insurance, and notes that real insurance involves a pooling of risks. "The insurer must make sure each new entrant to the pool pays a premium that reflects the expected costs that entrant brings to the pool. Otherwise, the insurer won't be able to pay claims. The business of insurance is the business of pricing and managing risk."

The Notwithstanding Blog - Genomic medicine, end-of-life care, and rationing are three "hot" areas of medicine and health policy in which much stock is given to the opinion of bioethicists. Our blogger at the Notwithstanding Blog (written by a first-year medical student) says that he has a bad feeling in observing the near-uniformity with which the bioethics establishment has opposed medical advancement and patient empowerment, and uses the lens of public-choice analysis to argue that the deference shown to their prescriptions is at least partially misplaced.

Pizaazz - In his post about how early career physicians use Facebook, Glenn Laffel reviews a study that should give some comfort to those who worry that physicians will misuse the social networking site by failing to protect patients' protected health information.

Workers Comp Insider - In the niche area of occupational illnesses and injuries, Jon Coppelman demonstrates that some villains contributing to skyrocketing health care costs might lie entirely outside the delivery system. He examines the curious spike in carpal tunnel injuries reported by guards at an Illinois correctional facility in his post John T. Dibble's Sympathetic Ear.

That wraps up this issue! Next up to bat: Louise Norris at Colorado Long Term Care Insider on February 16!

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February 1, 2011

 

This storm is a whopper of potentially historic proportion, with warnings and advisories covering a 2,000+ mile swathe from New Mexico and the Southern Plains to the upper Mid-Atlantic and New England. Four states - Kansas, Oklahoma, Missouri and Illinois - have already declared a state of emergency. More than one million square miles of the country are expected to be affected. And even if you live in a balmy state that is not directly affected, expect travel and business disruptions to spill over. (Or maybe the correct term is "snowball?")

If you get confused about the difference, here's a handy guide to how the National Weather Service defines Storm Warnings, Watches and Advisories and here is further clarification for winter weather terminology.

According to National Weather Service, about 70% of the injuries during winter storms result from vehicle accidents, and about 25% of injuries result from being caught out in the storm. Emergency workers who are out and about during the storm and in storm cleanup face additional risks.

Here are some of the most common winter workplace injuries and a toolkit of resources for prevention.

1. Driving accidents on slippery roadways or due to obstructed vision; Being struck by vehicles while working in roadways or while pulled over in roadways
CCOHS: Winter Driving Tips
OSHA: Safe Winter Driving
Mass. DOT: Safe Winter Driving Tips

2. Slips and falls on snowy or ice-covered outdoor walkways and wet indoor floors from snow or ice being carried in.
Winterize your workplace
7 Tips for Winter Slip and Fall Prevention

3. Hypothermia and frostbite due to cold weather exposure
CDC winter weather exposure
NIOSH: Cold Stress
Extreme cold prevention
In case you are stranded while driving in winter

4. Being struck by falling objects such as icicles, tree limbs, and utility poles
Natural disaster response: safety for cleanup workers

5. Falls from heights (roofs, ladders, lifts) while removing snow
OSHA Fall Protection
Safe snow removal
Safe work practices on snow covered roofs

6. Electrocution and burns from downed power lines, downed objects in contact with power lines, or ungrounded electrical equipment.
OSHA: Working Safely Among Downed Power Lines
OSHA Overhead Power Lines
Powerline Safety
NIOSH: Electrical safety
Electrical burns: first aid

7. Lacerations and amputations from unguarded or improperly operated snow blowers, chain saws and power tools
Practice snowblower safety
Mind the machinery while you work

8. Injuries from roof collapse under weight of snow
Preventing roof collapse in winter
Some roofs more prone to collapse

9. Exhaustion from working extended shifts
Fatigue
OSHA: Extended/unusual work shifts

10. Dehydration
Preventing dehydration in winter
Dehydration

11. Back injuries or heart attack while shoveling or removing snow
Snow shoveling is risky
Snow shoveling and snow removal safety

12. Carbon monoxide poisoning from generators used in improperly ventilated areas or from idling vehicles
Occupational Safety and Health Guideline for Carbon Monoxide

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