June 2012 Archives

June 28, 2012

 

Big day today! We're on the case.

We point you to the SCOTUS Blog - Live Blogging Coverage - this is the best place to be for informed commentary on the Supreme Court decision and what it means. They say that "We expect the health care decision to be announced at roughly 10:15a. 1045a-1p - live coverage and analysis."

We'll update this post periodically through the day with links and info as the day progresses so check back!

MSNBC: Supreme Court upheld the individual mandate as constitutional -- but under taxing authority. News media are scrambling to make sense of things.

SCOTUS Twitter feed

There are more than 800,000 people following the SCOTUS live blog right now. Amazing the role blogging is playing in disseminating news. Here is an ignominious "Dewey Wins" style screw up headline from CNN captured for posterity.

Talking Points Memo: BREAKING: Supreme Court Upholds 'Obamacare'

Full decision available at Ezra Klein's WonkBlog

President to make a statement at 12:15. You can watch it live at whitehouse.gov/live.

Helathcare Reform Implementation Timeline

‏We're making more frequent updates on our Twitter feed.

Tom Lynch, our CEO, weighs in:

American health care costs more than twice as much as the average for the rest of the economically developed nations making up the Organization for Economic Cooperation and Development (OECD), but our healthcare outcomes are generally worse than the average. We don't live longer and we're not healthier than the others.
Today's Supreme Court ruling upholding the Affordable Care and Patient Protection Act (ACA)is a major step forward in reversing our less than enviable world ranking. But it is only a first step. America's health care tree, now planted, will require frequent attention and pruning. Congress and the States will modify and improve the law just as we have done in Massachusetts.
Our Massachusetts healthcare law, passed under Governor Romney and the model for the ACA , envisioned tackling this problem in a two step fashion. First, by making health insurance mandatory for all citizens, and, second, by attacking the high costs. We've succeeded with step one. About 98% of all Massachusetts citizens are now insured. Two years ago, we dove into the deep end of the pool to begin the serious work of controlling costs. Since then, we've seen improvement, but we still have a long way to go.
I'm hopeful that now that SCOTUS has ruled all of us can put our collective shoulder to the healthcare wheel and begin improving our nation's health and lowering our costs.

Related: The Best Health Care in The World (PDF)

Updates:
Ezra Klein: The political genius of John Roberts

Jonathan Cohn: Did Roberts Gut the Commerce Clause?

Kaiser Family Foundation: State Action Toward Creating Health Insurance Exchanges, as of June 18, 2012

Kaiser Health News: After The Ruling: A Consumer's Guide

Kaiser Health News: KHN legal analyst Stuart Taylor: 'Most Amazing Supreme Court Theater I've Ever Seen'

Kaiser Health News: Political Leaders Sounding Off On Health Law Decision With Speeches
Senate Majority Leader Harry Reid, House Speaker John Boehner, House Minority Leader Nancy Pelosi, GOP presidential candidate Mitt Romney and President Obama react to Thursday's Supreme Court decision on the health law with speeches.

Charles Ornstein, ProPublica: Mystery After the Health Care Ruling: Which States Will Refuse Medicaid Expansion?

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June 27, 2012

 

Risk news from the front line - Louise from Colorado Health Insurance Insider posts the 160th Cavalcade Of Risk - Colorado Wildfire Season Edition and as per her signature style, she does a great job hosting. Our thoughts go out to her and everyone in Colorado, who are living out a real-life risk scenario this week. Over 32,000 people were evacuated from the path of the Waldo Canyon Fire near Colorado Springs and the U.S. Air Force Academy on Tuesday night, which is just boggling. There are some dramatic photos on BuzzFeed. You can also follow on Twitter #waldocanyon.

Industry pulse - Robert Hartwig is the president and chief economist of the Insurance Information Institute. His industry observations are well worth tracking so we point you to his his midyear Workers' Compensation update, where he tracks significant developments and issues both on the national and the state level. And because workers' comp is only the stubby little tail on the very large dog that is the property-casualty industry, we also recommend his Insurane Industry 2012 - First Quarter Results, of which we offer this brief excerpt:

Through the first three months of 2012, private sector employers added an additional 678,000 workers (and a total of 847,000 through May). Overall payrolls, the exposure base for workers compensation insurance, now exceeds its pre-crisis peak. During 2011, the unemployment rate ranged from a high of 9.2 percent in June to a low of 8.5 percent at year's end. By March 2012, the unemployment had dropped still further to 8.2 percent.
Despite extreme economic pessimism through much of the past two years, including the past several months of 2012, the economy appears to have successfully avoided a much feared and often discussed "double-dip" recession. Although real GDP growth came in at a disappointing 1.9 during the first quarter, economic growth is projected to reach 2.1 percent for full-year 2012 and 2.4 percent in 2013, according to Blue Chip Economic Indicators.

Extreme heat - FEMA / Ready.gov has issued before and during tip sheets on extreme heat in anticipation of the record-breaking temps that are expected to grip much of the country. The National Weather Service Warnings is a handy page to bookmark. The CDC offers Warning Signs and Symptoms of Heat-Related Illness, or see Medline for heat-illness information in multiple languages.

OSHA Training & Temp Workers - In HR Hero, John Hall tackles the issue of OSHA training and temporary workers. Where does the responsibility lie, with the temp agency or the client employer? He notes that OSHA often finds that permanent employees are properly trained as required by a particular standard but their temporary counterparts aren't, which then results in citations and significant penalties. He discusses some of the areas of responsibility that lie with the client employer vs the temp agency. It's an issue worth your attention. Consider the $700,000+ fine for lack of training that OSHA just imposed related to the on-the-job death of a contract worker at Tribe Mediterranean Foods, a Taunton MA subsidiary of Nestle SA. "OSHA's investigation found that Tribe Mediterranean Foods had not trained the deceased worker and six other workers who cleaned plant machinery on hazardous energy control or "lockout/tagout" procedures." OSHA also issued several willful violations, defined as, "... one committed with intentional knowing or voluntary disregard for the law's requirements, or with plain indifference to worker safety and health."

PTSD - Today is PTSD Awareness Day and the National Institute of Mental health is an excellent resource. Also see that National Center for PTSD, which offers resources for veterans, their family members, and others who have gone through trauma and suffer from PTSD.

Noteworthy news briefs

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June 26, 2012

 

Here in New England, Lightning Strike Awareness Week kicked off with some drama. A Connecticut woman suffered second- and third-degree burns after being struck by lightning at a campground outside Norwich, the lift bridge between Maine and New Hampshire was closed for a few hours after direct lightning hit, and lightning was the likely suspect in a few house fires in Connecticut and Massachusetts.

On average, 54 people die from lightning strikes each year - that number of fatalities has been trending down in recent years (29 each in the past two years), the improvement credited partly to the massive public awareness and information campaigns. More than half of all fatalities involve recreational activities such as golfing and boating, but electrical storms are a very real hazard for workers, too. Some of the high risk workers include loggers, construction and building maintenance workers, lifeguards, farming and agricultural workers, lawn care workers, road crews, roofers, telecommunications and utility workers, plumbers and pipefitters, and heavy machinery/equipment operators. See NOAA's Outdoor Safety tips and the eLCOSH Lightning Safety page.

It should be noted that in addition to lightning fatalities, hundreds more people suffer lightning strike-related injuries each year - about 80-90% of the people who are hit by lightning survive the ordeal. These survivors pose interesting case studies - many suffer from unusual and little understood medical effects that can clear up relatively quickly or linger for a lifetime. See Medical Aspects of Lightning and NASA's fascinating Human Voltage page. This video also includes some interesting first-person accounts:

Lightning Safety Resources

National Lightning Safety Institute, which includes information on
Structural Lightning Safety
and Personal Lightning Safety

Lightning Safety Resources and Tool Kits from NOAA

The one in a million club you don't want to join

Lightning Safety Guidelines

Lightning Strike and Electrical Shock Survivors

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June 25, 2012

 

Kelly Taylor worked as an accountant for Community Health Partners (CHP) in Montana. On her way out for lunch in May 2009, she slipped on the stairs and landed on her tailbone. Her primary caregiver, Rebecca Hintze, worked for the same employer and provided medical advice soon after the injury. The claim was accepted by the Montana State Fund. Taylor suffered from pain off and on over the following months, using up her sick leave in a random succession of 1-3 day episodes. She did not seek comp indemnity for these incidents as she mistakenly thought comp required 4 consecutive lost days.

Over a year later, in September of 2010, Taylor was sitting on a couch at home. She put her foot on her coffee table and bent over to paint her toenails. When she finished, she tried to stand up, but immediately had difficulty, experiencing extreme pain in her back and down the front of her leg. In the following weeks, she experienced this sharp pain two more times, once after stubbing her toe on a rug at CHP and again when she was scooping out cat litter. (For all the severity of the injury, this case is sublimely prosaic in terms of risk.)

Because of the long gap between indemnity payments, and because an IME found that the herniated disc following the pedicure was a new injury and not a recurrence of the old one, the claim was denied. Taylor appealed, and the case came before the estimable Judge John Jeremiah Shea, whom we have encountered a couple of times in the past: in the notorious "pot smoking with bears" incident, and in another complicated claim involving a non-compensable back injury.

Dispensing Dispassionate Justice
Judge Shea appears to be a relentless seeker of fact and a dispassionate purveyor of justice. While he praises both the IME doctor (for reasonably concluding that the pedicure incident involved a new injury) and the claims adjuster (for reasonably denying benefits), he over-ruled the denial and reinstated the benefits. He found continuity in the documented self-treatment and in the somewhat informal, ongoing treatment provided by Rebecca Hintze. While the IME doctor had stronger credentials and a longer track record, Hintze had "substantially more opportunities to observe and talk with Taylor about her injury in both formal appointments and in informal workplace conversations."

He concluded that the pedicure injury was an aggravation of the back injury suffered over a year prior. At the same time, he denied an award for attorney's fees to Taylor, as he found that in denying the claim, the adjuster had acted reasonably.

All of which might appear to be much ado about not much, but in the intricate and ever-evolving world of comp, this case embodies a core value of the system: the relentless effort to determine whether any given injury occurred "in the course and scope of employment." Judge Shea, connecting the dots as methodically as a detective, concludes that the pedicure injury was an extension of the original fall. While the ruling itself can be questioned, Judge Shea's method and discipline are beyond reproach .

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June 22, 2012

 

Joe Paduda waited until the very last minute this week to see if we would get a decision before releasing this week's Health Wonk Review, but looks like we will all be held in suspense for a few more days!

But never fear, our healthcare policy pundits still have a lot to say and Joe does a find job presenting it. Go visit his Health Wonk Review isn't waiting for the Supremes... - and he'll probably have an addendum next week when word comes down from on high!

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June 20, 2012

 

The deceased: a police officer. A nurse in training.
The perpetrators: A prison guard. A surgeon.

These recent deaths were two of the approximately 5,000 on-the-job fatalities that occur each year, and both both were related to domestic violence. We mention the professions of the parties involved simply because domestic violence is often assumed to be an issue that doesn't happen to "people like me" or that it primarily occurs in certain economic strata. These myths and stereotypes are part of the reason that it can be such a hidden problem.

In the case of Officer Kevin Ambrose, a 36-year veteran of the Springfield MA police department, he was shot and killed in the line of duty while protecting Charlene Miller and her baby from a former boyfriend. Miller was also shot but survived; Miller's baby was unharmed, largely thanks to Officer Ambrose's courage. The assailant, Shawn Bryan, a Rikers Island corrections officer, took his own life after the shooting.

Last week, Jacqueline Wisniewski was stalked and gunned down in Buffalo Hospital. Her murderer was a surgeon at the hospital, her coworker and a former boyfriend. The hospital and nearby schools were locked down for a few hours after the incident because it was unclear if this was a targeted incident or a shooting spree. Timothy Jorden, a trauma surgeon at the hospital and a former army Special Forces weapons expert, was identified as the assailant by witnesses and an all points bulletin was issued. He was found dead at his home two days later.

These tragic events are part of a phenomena called "domestic abuse" or "domestic violence" - misleading terms at best. The word "domestic" softens the edges of a brutal reality, and implies that it is something that happens behind closed doors, not our business. Yet it is indeed something we should be making our business and it is clearly not something that is confined to the home. Increasingly, the violence plays out or culminates in the workplace as assailants are stalked; it also takes the lives of working police officers and first responders.

According to a recent report in the Annals of Epidemiology, homicide is a leading cause of occupational death in U.S. women. There were 142 homicides among women at work resulting from intimate partner violence from 2003 to 2008. While the rate of homicides in the workplace has been trending down, the percentage of homicides against women at work increased in 2010 to 13 percent. Those at highest risk were in the health care, production, and office/administration professions. More than half the homicides occurred in parking lots and public buildings.

Types of workplace violence
Work violence generally falls in one of four buckets. It is helpful to segment them by type because the risk management and prevention measures can vary. The types of violence include:

  • Criminal outsiders, which includes robberies, rapes, and random violence by strangers. This type of violence is common in organizations that handle money, financial transactions, and drugs. Risk mitigation can include staff training and addressing environmental issues such as better lighting, customer/worker barriers, lockboxes, alarms, and closed circuit videos.
  • Organizational clients - this is violence committed by customers, patients, or other recipients of the business services. Healthcare workers in particular suffer many incidents at the hands of patients and family members. These might include rage-related incidents and incidents related to mental health issues or persons under the influence. Risk mitigation measureless include staff training and environmental controls.
  • Lateral or worker on worker violence, which includes the so called "going postal" incidents and retribution for firings or other work-related issues. Although these incidents are the ones that make the headlines, they are the least common. Mitigation measures include better hiring practices, such as background and reference checks, zero tolerance policies that are enforced (including anti-bullying measures), manager and supervisor training, anger and stress management training for workers, availability of an EAP. Particular measures may need to be taken at points of high stress, such as layoffs or job loss.
  • Domestic violence - this involves an employee involved with a spouse or significant other; it also includes coworkers who might be coincidentally caught up in events or first responders who are injured when trying to help the victims. This is the most difficult one to address since it stays "underground" until a serious point of escalation. The best way to deal with this potential is proactively as part of an organization's health and wellness effort by publicizing the issue and publicizing the availability of resources to help. More and more progressive companies are addressing the issue. The Corporate Alliance to End Partner Violence is a national nonprofit organization dedicated to partnering with businesses to help reduce the costs and consequences of partner violence at work. From policies and programs to legal issues and legislation, CAEPV is a credible source for information, materials and advice. It's an excellent source of best practices for corporate programs to prevent partner violence and offers concrete help for employers in starting a workplace program.

Why should employers care?
Employers are involved in domestic abuse whether they want to be or not. Futures Without Violence delineates Seven Reasons Employers Should Address Domestic Violence not the least of which are that it is a pervasive issue, it poses security and liability issues, and it results in significant lost time and lost productivity. A 2003 CDC study revealed that domestic violence accounts for nearly 8 million lost work days, the equivalent of more than 32,000 full-time jobs.

Plus, it is a morale issue. Studies show that 84% of surveyed employees believe that employers should get involved in the solution to the problem of domestic abuse. Yet there is a discrepancy, because at the time of this survey, just 13% of executives surveyed thought it was the company's job to help solve the problem.

Workers' comp is simply not an issue that can easily be siloed off from other aspects of a workers' life. We certainly see that with health issues and so-called lifestyle issues that complicate worker's comp claims. So, too, with domestic violence. While the employer may or may not be shielded from compensability in incidents of work violence, that sometimes simply opens the door to liability in the courts for other reasons: negligent hiring, lack of security, etc. While it's important to address the safety issues directly related to the job, it makes economic sense to have health and safety be part of an overarching wellness program that addresses health-related issues that occur both on and off the job.

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June 19, 2012

 

We live in the digital age, with all its conveniences and consequences. It would be hard to imagine a law requiring that all telephone calls be routed through live operators, or limiting maps to those that can be purchased at your neighborhood gas station. But each technological innovation creates a few new jobs and, seemingly, the loss of many others. Which brings us to the continued - and mandated - use of stenographers in virtually every workers comp claim filed in New York.

Senator Diane Savino (D-Staten Island) has filed S. 4112, which would certainly help the employment prospects of stenographers in the Empire state. Following an aborted effort by the NY workers comp board to test the use of digital recording in a few of the 300,000 or so annual workers comp hearings, Savino wants to ban digital recording from any comp hearing and require stenographic reports as the sole recognized form of documentation. Her bill, currently under consideration, would make stenographers a permanent fixture in workers comp for years to come.

Stenographers and their allies will argue that their presence improves the accuracy of court reporting. There are fewer "inaudibles" in their transcripts. But such accuracy comes at a substantial cost. The wages of a stenographer are in the $50-60K range, plus benefits. The cost of installing digital recording equipment in a courtroom runs less than $20,000, and once installed, the cost of maintenance is minimal. The trade off becomes even more reasonable when you consider that the New York system requires an unprecedented number of hearings for each and every workers comp claim.

In contrast to virtually every other non-monopolistic jurisdiction, New York insurers and TPAs are not allowed to make routine, unilateral changes in the status of any claim. A change in claim status requires a hearing, in front of a judge, complete with legal representation on both sides and a stenographer. This is enormously redundant and, in a word, non-sensical. It is also the root of New York's highest-in-the-country, soon-to-go- higher administrative costs. On a per capita basis, New York has more judges, more bureaucrats, more hearings, more paper flow - and more stenographers - than any other competitive state.

No Easy Answers
The fundamental goals of reasonable reform in New York can be easily stated: improve benefits for injured workers and lower the exorbitant cost of insurance for employers. It is not difficult to imagine how this can be done: simply look at the way most other competitive states manage workers comp claims. New York would have to streamline its entire system: instead of operating like a monopolistic state, micro-managing every claim, New York could empower insurers and TPAs to manage claims as skillfully and independently as they do in other states; by doing away with unnecessary hearings and hugely redundant reviews of literally millions of forms, New York could substantially reduce staffing levels at the Workers Comp Board.

But efficiency comes at a cost. One person's cost savings is another's job loss. These needed reforms would eliminate many, many jobs - and in doing so, would throw hundreds of loyal workers into the already burgeoning unemployment lines. In this one small example, the elimination of stenographers from hearings would lower administrative costs, even as it would increase the unemployment of people with potentially obsolete skills. This is not an easy trade off, but a necessary one.

At some point, New York has to look at the big picture: workers comp is way too expensive, even though the benefits, for the most part, are mediocre. Every adjustment to the current statute, every administrative decision, should pass through a single filter: does this improve the benefits to injured workers and does it reduce the cost to employers? When you run Senator Savino's S. 4112 through this filter, it's not part of the solution, but just another clog in an already overloaded drain.

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June 15, 2012

 

Wallace Weatherholt, AKA Captain Wally, was leading a family on an air-boat tour of the Everglades. To liven things up, the 63 year old captain apparently dangled some food over the side of the boat. An alligator obligingly leapt out of the water to consume the (illegal) snack and took off Wally's hand in the process. To the gator, the hand was part of the snack - and who could argue with that? Unfortunately for the gator, authorities killed it to retrieve the hand, although doctors were unable to reattach it.

We will not try to determine which creature acted with greater stupidity, although it's clear that the gator did only what gators have done for millions of years, while Wally did what thinking humans are not supposed to do. (Feeding gators is illegal - a misdemeanor - for somewhat obvious reasons.)

Wilful Intent?
The issue here is compensability: Captain Wally was clearly injured "in the course and scope of employment" - but is this a compensable injury? Did Captain Wally cross the line to "wilful intent" and thus disqualify himself from workers comp benefits (which, by the way, will be substantial, given the severity of the injury and the permanent loss of a hand)?

This might sound like "wilful intent" but it may well prove compensable. The issues for review include:
- Did Captain Wally's employer have a written policy against feeding alligators?
- Was the enforcement documented? Were their punitive consequences for the act?
- Has Captain Wally's unsafe practice been observed in the past and if so, what was done about it?

If Captain Wally's employer turned a blind eye to this practice, which, parenthetically, was good for business, the employer and the insurer will own the injury. Unless the prohibition is an explicit condition of employment, in all likelihood the employer will be on the hook for the loss. As for Captain Wally, he, too, will be on a hook of a different sort: he will have a permanent reminder of his ill-advised and illegal feeding of a primitive creature who was minding his own business until an attractive snack caught his impassive eye. I do feel for Captain Wally, but hands down, my greater sympathies are with the gator.

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June 13, 2012

 

Risk Roundup - Cavalcade of Risk #159 - Early Edition is posted at My Wealth Builder. We'd like to highlight Jason Shafrin's post as particularly noteworthy for our readers: Healthcare Costs to Rise by over 7 percent in 2013.

Creeping catastrophics - Our colleague Mark Walls has a good article in Business Insurance on Creeping Catastrophic Claims - How to Spot Them and Stop Them. "These claims start out like any other case, usually with a back, knee or shoulder injury. However, because of a series of events, they end up costing the employer hundreds of thousands of dollars. These developmental claims share many common characteristics that, if identified and addressed in a timely manner, can prevent significant adverse development of the claims."

Big bucks fraud - John D'Alusio unpacks the AIG debacle and explains how it hurts us all in his post Gaming the Workers Comp System at Workerscompensation.com.

Ergonomics of obesity - What does obesity look like to a workplace ergonomist? "Increased obesity in the workplace means more arthritis, larger waist circumferences, additional work limitations, compromised grip strength, decreased lower limb mobility and medical risks. Obese employees might be more vulnerable to falls and their manual material handling ability may be compromised. Obesity also can impact self-esteem, motivation, absenteeism, presenteeism, premature mortality and more." More at Ergonomic Strategies for Managing Obesity in the Workplace

Case Law - The Tennessee Supreme Court found for an employer in a statute of limitations case involving PTSD. The employer argued that the statute of limitations clock began ticking when the event that caused the trauma occurred (viewing the bodies of two co-workers killed on the job), but the court found that the statute of limitations does not begin to run until an employee discovers the injury and, in this case, the employee did not know he had PTSD until some time after the workplace deaths occurred.

DOL Transparency - In 2011, the Department of Labor proposed a rule strengthening safety provisions for children under age 15 who work on farms. The rule had a parental exemption so that kids could still work on family farms. Apparently, industry pressure led DOL to withdraw the rule. DOL also removed the proposed rule from its website and Celeste Monforton posts that Government transparency groups are asking the Labor Dept to restore info scrubbed from website.

Texting while driving - Steve Yahn of Risk & Insurance looks at how Companies Fight Against Texting and Driving. He notes, "Gavejian and other experts who work with companies to develop cell phone and texting policies said that businesses need to first assess how technology is used in their workplace on a daily basis."

Food processing hazard - A new report describes two cases of poultry workers who developed chronically swollen knuckles, the hallmark sign of a rare skin condition known as pachydermodactyly: Hand deformities turn up in poultry workers, report finds.

Other noteworthy news


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June 11, 2012

 

The immortal Mae West once said that "too much of a good thing can be wonderful." When it comes to pain relievers, however, too much of a good thing can kill you. Which brings us to the sad saga of Anthony Sapko, who died of an accidental prescription drug overdose in August of 2006. Sapko worked as a policeman for 21 years in New Haven, CT, and went on in the mid-1990s to become a state corrections officer. Beginning in 1999, he was treated for depression. He suffered four work-related injuries while working in corrections, the last being a back problem from which he never returned to work.

Sapko was treated with a cornucopia of medications: oxycodone, Zanaflex, Kadian, Celebrex, Roxicodone, Avinza, Lidoderm patches and Duragesic. When his depression deepened in 2006, his psychiatrist prescribed Seroquel. Two weeks later, Sapko was dead. The autopsy revealed a level of oxycodone 20 times normal, and of Seroquel at 5 times normal. The combination of the two over-consumed drugs proved both toxic and fatal.

Suicidal Intent Vs. Accident
Sapko's widow filed for workers compensation death benefits. The claim was denied at the Commission level and again at the Appeals Court level. Sapko's widow argued that the death was directly related to his workplace injuries, but the court found a disconnect: this was not a suicide (where such a link might be established), but an accidental overdose.

In a December 2011 blog, we made note of two similar cases: a compensable case in Tennessee and a denied case in Ohio. Fatal overdoses, in other words, may or may not be compensable, depending upon the specific circumstances and state-based precedents. But the over-arching issues are clear: the abuse of prescription narcotics has reached epidemic proportions in workers comp; some individuals are unable to properly self-manage the use of these medications; and doctors are all-too-too willing to prescribe very powerful drugs to alleviate pain.

Workers compensation is endlessly fascinating because it inevitably brings together pain (from workplace injury) and pain suppression (far too often, opioids). In Sapko's foreshortened life, the combination of medications was toxic. In workers comp as a whole, the mixture of pain and drugs is proving to be a formidable problem.

No Will, No Way?
One of the interesting sidebars in this case is the concept of wilful misconduct: when an injured worker abuses prescription medication, is this a "serious and wilful" action that precludes compensability? Or is the pain so consuming and the drugs so powerfully addicting, that the concept of "wilful" disappears in a drug-induced haze? There are no simple answers. There is undoubtedly some link between Sapko's depression, the work he performed and the injuries he suffered. But in the world of comp these links must be explicit and, unlike life itself, unambiguous. It would require a novelist to reveal the connections. Unfortunately for Sapko's widow and children, the commissioners and judges in charge are simply not in a position to craft that kind of narrative.

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June 8, 2012

 

Maggie Mahar has posted the Voices from the Blogosphere edition of Health Wonk Review at healthinsurance.org blog. It's a robust edition with talk about individual rights, the upcoming SCOTUS decision, the proposed ban on sugary drinks, and more. Maggie is one of the healthcare bloggers that we follow regularly. She's an author and a financial journalist who has written extensively about the U.S. health care system over her career. Stop by to check out her curated compilation of healthcare policy posts.

Other noteworthy news & views
This is an urgent message if you are using business network LinkedIn: LinkedIn Users: Change Password Now

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June 5, 2012

 

Derek Boogaard was a hockey player. Well, sort of. He didn't score goals (only 3 in 6 years) and he spent a lot of time in the penalty box (589 minutes). He was an enforcer: at 6'8" he was a ferocious and much-feared brawler.

As we learn in a New York Times article, he was also addicted to pain medications. While still playing hockey in 2008-2009, he received at least 25 prescriptions for opioids from ten doctors, a total of 600+ pills: eight team doctors of the Wild (his team at the time), an oral surgeon in Minneapolis and a doctor from another NHL team.

In 2010, he was signed by the New York Rangers for $6.5 million, despite his by then well-documented drug problems - he was an active participant in the NHL's substance abuse program. While playing for the Rangers, a team dentist wrote five prescriptions for hydrocodone; another team doctor wrote 10 prescriptions for Ambien.

Occupation-related Pain
There is not much question that Boogaard suffered from pain. Here is just a small segment of his pain-filled saga, from the final few months of his career: In October 2010, a punch from a Toronto player broke a three-tooth bridge in his mouth. A couple of days later, he hurt his hand while punching a Boston player. In November he had his nose broken by an Edmonton player. In December he suffered a concussion in a fight with an Ottowa player. He never played hockey again.

In the months following his retirement, he exhibited erratic behavior and wild mood swings. He acquired numerous prescriptions from current and former doctors. In May of 2011 he signed himself out of a rehab facility, spent a night drinking with friends, and died of an overdose in his Minneapolis apartment. He was 28 years old.

Privilege Has Its Pain
The article quotes Dr. Jane Ballantyne, a pain expert from the University of Washington: "A single course of opiates might be O.K. for normal people who only get injured once in a blue moon, but when injuries are frequent, it can easily turn into chronic treatment instead of just acute treatement. And athletes are at high risk of developing addiction because of their risk-taking personalities." She adds: "the tendency is to overtreat" because team doctors want to help athletes return to competition." [At LynchRyan, we are strong proponents of prompt return to work, but only where there is no risk of re-injury. There is no such thing as modified duty on ice.]

Boogaard was a fan favorite wherever he played. In hockey, fighting is "part of the game." But his sad saga is primarily a story of brain injury and addiction. As a professional athlete, Boogaard had virtually unlimited access to drugs, through doctors who, for the most part, did not bother to document their treatment plans or monitor their patient.

It should come as no surprise that an autopsy revealed that Boogaard had chronic traumatic encephalopathy C.T.E., a brain disease caused by repeated blows to the head.Thus he is linked in death to the growing number of football players who suffered the same fate, the result of frequent concussions.

Official Response Speak
As a lifelong student of language and rhetoric, I cannot miss an opportunity to quote some of the official responses to Boogaard's death:

The NHL: "Based on what we know, Derek Boogaard at all times received medical treatment, care and counseling that was deemed appropriate for the specifics of his situation."

The Minnesota Wild: "The Wild treated Derek's medical status in accordance with the NHL/NHLPA Substance Abuse and Behavioral Health Program as we do with all our players."

The NY Rangers: "We are confident that the medical professionals who treated Derek acted in a professional and responsible manner and in accordance with their best medical judgment. They took extraordinary steps to coordinate the medication prescribed for him with the professionals in charge of the NHL-NHLPA Substance Abuse and Behavioral Health Program."

Not exactly heartfelt or compassionate, just the voices of powerful corporations, protecting their interests, their brands and their proverbial asses. As for Derek Boogaard and his misguided career on ice, RIP for the man who knew no peace.

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June 4, 2012

 

Risk roundup - Nina Kallen posts the latest Cavalcade of Risk at Insurance Coverage Law in Massachusetts - check it out.

Mining - Joe Paduda talks about the growth of the mining industry, noting that it is up almost 60% over the last ten years, with an increase of 12% since the beginning of 2011 - a growth rate that looks like it will surpass the BLS ten-year projection of 24%. Joe notes that regulators, work comp executives and providers should be on alert since this growth will have a dramatic impact on selected states, citing North Dakota as one example.

Disparity in healthcare costs - Dave DePaolo has an interesting post on the wide disparity in cost for cash paying patients vs insurance. He points to a recent LA Times article that cited numerous real world examples (routine blood work was charged $782 by the hospital, $415 by the insurer, and $95 if paid in cash.) DePaolo asks: "What would fee schedules look like if those in charge of these pricing decisions shared with payers and regulators all of the data that identified each friction point in insurance based reimbursement schedules versus getting paid cash?"

Florida drug repackaging - Do the people who write the biggest checks to politicians determine the cost of workers comp in Florida? That's a question many keep raising, and it appears so. In the article drug-bill battle is lucrative for lobbyists, legislators, Aaron Deslatte of The Orlando Sentinel talks about how Broward County's Automated Health Care Solutions has invested nearly $6 million into lobbying to protect the practice of drug repackaging by physicians. Why should this issue be of concern to Florida employers and insurers? Joe Paduda offers a primer on repackaged drugs and the effect on work comp costs.

E&O and workers comp - Workers' compensation is the leading cause of agent in E&O claims, accounting for approximately 10% of all claims annually, according to Curt Pearsall. He notes the majority of claims involve the following issues: Questions involving coverage for sole proprietors, partnerships or single-member LLCs; Dealing with a broker to place coverage for that "tough" risk; Dealing with the state workers' comp market to place coverage; Ensuring employees in all states are covered; Placing clients in a trust/alternative program; and U.S. Longshoreman and Harbor coverage.

On reforming SIGS - At LexisNexis Workers' Compensation Law, John Stahl offers a summary and some of the salient points of the International Association of Industrial Accident Boards and Commissions' (IAIABC) recent report on self-insurance groups (SIGs): Regulatory Challenges Regarding Self-Insured Groups: Failures Prompt New Regulation. He notes that employers liked the low cost of joining an SIG but did not realize the potential liabilities associated with that choice, and that many employers made the false assumption that they were protected by state regulation. The full IAIABC report is available for $45: Self-Insured Groups for Workers' Compensation: Effective Regulatory Strategies.

CA protects hair care workers - Jon Gelman posts about a groundbreaking settlement in California that protects hair care salon workers. The settlement was between California's Attorney General and manufacturers of Brazilian Blowout hair smoothing products that contain a cancer-causing chemical. In addition to paying fees and penalties and implementing safeguards for workers, hair care facilities must warn the public about the cancer-causing potential of the chemicals used in the procedure and must cease deceptive advertising.

Poultry workers push back - Citing concerns over worker and public health, poultry workers, safety advocates, and groups ranging from the Southern Poverty Law Center and the National Council of LaRaza, to the American Public Health Association and Nebraska Appleseed all united in opposition to USDA's proposed 'modernization" plan that would shift work from inspectors to workers. At The Pump Handle, Celeste Monforton talks about this issue: Public health officials urge USDA to withdraw plan to 'modernize' poultry inspection, worker and food safety will suffer.

A Request for Help Bob Wilson calls all UR hands on deck for participation in Health Strategy Associates' survey. Learn more here: Your Opinion Needed on Critical Utilization Management Survey.

Migration from Mexico - Peter Rousmaniere posts about a recent Pew Hispanic Center Report on Mexican migration, which states that, "The largest wave of immigration in history from a single country to the United States has come to a standstill. After four decades that brought 12 million current immigrants--more than half of whom came illegally--the net migration flow from Mexico to the United States has stopped--and may have reversed."
Some of the factors cited as contributing to this change include the weakened U.S. job and housing construction markets, heightened border enforcement, a rise in deportations, the growing dangers associated with illegal border crossings, the long-term decline in Mexico's birth rates and changing economic conditions in Mexico.

it would be funny if it weren't so true - Cartoonist Jen Sorenson issues An Open Letter To The Supreme Court About Health Insurance.

Death on the Job The Weekly Toll.

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