Annals of Fraud: Trifecta for Bay Area GC
In the world of workers comp, there is no lack of opportunity for fraud. We've seen doctors rip off the system by billing for services that were either never provided or not needed. We've seen employees fake injuries (relatively rare) or malinger on comp long after injuries have healed. We've seen insurance agents pocket money intended for insurance premiums. We've seen insurance adjusters embezzle claims funds. We've seen state comp bureaus (Ohio) engage in fraud. And we've seen employers rip of the system in a number of ingenious ways.
Which brings us to the saga of NBC Contractors (presumably no relation to the television network), a California general contractor. Three owners of the company - Monica Mui Ung, 49, of Alamo; Joey Ruan, 31, of San Leandro; and Tin Wai Wu, 28, of Millbrae - have been charged with 48 counts of insurance fraud, labor code violations and tax fraud. Bail was set at $535,000 for each of them. (You can check out their bare-bones website here.)
With Ung listed as the (minority, female) owner, NBC Contractors qualified for preferential treatment on public projects. Between 2003 and 2007 they successfully bid on 27 public works projects, including El Cerrito City Hall and Piedmont Elementary School.
According the indictment, NBC used a trifecta of cost cutting measures:
1. They underpaid workers comp premiums a total of $1.45 million, by misclassifying their workers into lower risk occupations and by under-stating payrolls
2. They violated fair labor standards, by failing to pay for overtime or sick leave, impacting 19 workers a total of $3.6 million
3. They underpaid payroll taxes on workers, depriving state and federal government of tax revenues
With these (criminal) "cost savings," NBC was able to underbid their competitors. These business practices cheated a lot of people: NBC's own workers, their insurance carrier, their competitors, and all law-abiding businesses who played by the rules. We can only hope that the quality of their work was up to standards, which would at least keep their customers off of the long list of parties directly injured by their actions.
Bosstown's Health Wonk Review, and assorted other news briefs
Check out Health Wonk Review: Bosstown edition. Tinker Ready at Boston Health News makes her debut as host with an informative and entertaining edition of the biweekly roundup of the best of he health policy blogs.
Michael Fox of Jottings By an Employer's Lawyer offers a great rundown of Supreme Court Nominee Sonia Sotomayor's opinions on labor and employment law.
More state AGs file against Chrysler bankruptcy - we've blogged about Michigan and Ohio; now Illinois and Indiana join the list of AGs that are attempting to protect both workers and their state workers comp systems from any adverse effects. The bone of contention is that under the terms of the proposed sale, Fiat would not be required to assume workers' compensation liabilities of injured Chrysler workers and individual state systems would be forced to deal with these uncovered workers.
Joe Paduda of Managed Care Matters has completed his firm's First Annual Workers Compensation Bill Review Survey.
Peter Rousmaniere's article A Brutal Interpretation in Risk and Insurance tells the story of Taha Saad's unfair treatment under the defense Base Act. Saad, an Iraqi translator, worked for the Army until he lost his legs in an IED explosion. A U.S. Department of Labor judge recently affirmed AIG's weekly payment of $46.15 for his permanent disability.
Clamping Down on Claim Costs - nine practical tips for managing workers' vomp losses by Lori Daugherty of Claims Magazine
Aging America: A Looming Catastrophe?
Take 78 million Baby Boomers and their retirement plans, mix with a woebegone social security system and the global economic meltdown of 2008/2009. Add in rising health care costs and the insurance industry’s natural propensity to avoid troubling issues, and you have a recipe for a looming catastrophe of the first order. That's the premise that Lynch Ryan CEO Tom Lynch puts forth in his article in the current issue of the IAIABC Journal, Aging America: The Iceberg Dead Ahead, which IAIABC has given us permission to make available to our readers.
Tom describes the massive problems that the aging workforce presents to workers compensation systems - problems that are compounded by funding problems with other social insurance programs. He makes the case that neither states, the federal government, or insurers are prepared for the claims and cost problems that will develop over the next decade, and offers recommendations to address these problems, including the creation of a special federal commission.
Admittedly, we are partial to the author, but we think the article is worth a read.
In addition to putting in a plug for the article, we'd like to call your attention to the publication that it appears in. The IAIABC Journal is published two times per year by the International Association of Industrial Accident Boards and Commissions (IAIABC), an association of government agencies that administer and regulate their jurisdiction’s workers' compensation acts. It's a peer-reviewed Journal, and one of a few remaining venues that publishes original research papers and in-depth treatment of workers compensation issues and opinions. Issues are substantial - the current issue weighs in at 158 pages. It is edited by Robert Aurbach. For a sampling of content, we've taken the liberty of printing this issue's article abstracts to give you a flavor - click to continue.
Waiting for the Crisis - Peter Rousmaniere
Predicting the future of workers compensation involves specifying the scope of changes that may occur. The workers compensation system changes radically only when provoked by a major crisis. In the future, Federal concern over the growth of federal disability benefit spending (SSDI) may provoke a crisis in the workers compensation system, because it is an important feeder of SSDI claimants. The term “crisis” is not appropriate to two other developments that still deserve notice. These trends are the growth of medical costs and the deepening of investment by insurers and other parties in information technology.
The Evolution of Workers’ Compensation: Work Injury Insurance - David J. DePaolo
A national universal health care model would make medical care in workers’ compensation irrelevant. Without the medical component, workers’ compensation will evolve to work injury protection plans where the incentives are designed to reward productivity.
Aging America: The Iceberg Dead Ahead - Tom Lynch
The aging of the workforce presents massive problems to workers compensation systems. The problem is compounded by funding problems with other social insurance programs. Neither states, the federal government, or insurers are prepared for the claims and cost problems identified here. Recommendations are offered to address these problems, including the creation of a special federal commission.
New Administration and Congress and the Economic Downturn May Provide Opportunity to Fix Bankruptcy Code Flaw Adversely Affecting Workers’ Compensation Claims - Eric Oxfeld
This article discusses the problems associated with workers’ compensation claims when a self-insured or illegally uninsured employer files for bankruptcy. It also describes the benefit of mending the Bankruptcy Code to add protections for workers injured on the job, comparable to protections now provided for wages and other types of employee benefits.
Musculoskeletal Impairments - A Comparison of Evaluations Using the AMA Guides 4th, 5th and 6th Editions - Mark Melhorn
This paper illustrates the development of various editions of the AMA Guides to the Rating of Impairments, along with criticisms of the AMA Guides. It focuses on the axioms and other novel features of the 6th Edition of the AMA Guides. It offers the author’s reflections on the limitations of the new AMA methods and his suggestions for improvement.
Introducing Identity Resolution A New Approach to Workers’ Compensation Fraud - Charles Clendenen
Workers’ compensation fraud is a serious problem for the various workers’ compensation systems administered by states nationwide. The Ohio Bureau of Workers’ Compensation, for example, estimates that they pay as much as $320 million annually in fraudulent claims (2008). This paper briefly reviews the three major classes of workers’ compensation fraud, i.e., fraud committed by medical providers, by employees making claims, and by employers who avoid paying premiums. The article then introduces a new technology, called “identity resolution,” that is being applied to the workers’ compensation employer fraud problem. Next, the software and how it works is described, followed by a discussion of the return on investment (ROI) that agencies may expect to derive through better detection of employer fraud.
Preventing Further Harm to the Harmed – Towards a Therapeutic Approach to Workers’ Compensation - Robert Guthrie and Stephen Monterosso
Workers who contract disease or who are injured in the course of their employment not only suffer the consequences of a work injury or disease in terms of disability and impairment. In addition some workers are subjected to a myriad of claims procedures, medico-legal investigations, dispute processes and surveillance which retards recovery and produces further assault on the workers’ physiology and psychology. The delay in recovery for these workers has economic consequences for
them, the employer and the economy as a whole. The consequences of this double harm frequently arise out a deep scepticism directed towards claimants. Often inexperienced claimant litigants seek workers’ compensation income support from government and corporate agencies who are frequent players in a complex legal and medical system. This paper sets out to develop guiding principles by which a workers’ compensation system should operate. Based on the principles of therapeutic
justice and adopting a principle of Above all, Do no Harm, the paper posits that systems of income support for disability and impairment should be premised not only on the provision of adequate income support for workers who are harmed through work, but also on the prevention of further harm to the worker through bureaucratic claims processes, over zealous claims management and lack of good faith in claims handling. It asserts that having such guiding principles provides a sound economic, medical and ethical basis for income support.
An Evaluation of the Effectiveness of Using a Prospective Peer Review Process to Control Excessive Physical Therapy Visits - Janet Jamieson
This study analyzed the effectiveness of using a prospective peer review process to control excessive physical therapy visits for workers’ compensation injuries. The study was based on a national data base of physical therapy claims. The claims included those that were processed through a bill review process and claims that were provided a prospective peer-review. The top five cost driver diagnoses were identified and the average number of visits and most frequent treatments provided were identified for both the peer-reviewed and non peer-reviewed claims. The results showed the peer-review claims had a slightly higher average number of visits for all five diagnoses than those without peer-review. This appeared to be due to the increased severity of the claims that were pre-identified for the peer-review process. Both peer-reviewed claims and non peer-reviewed claims had a number of claims with excessive physical therapy visits. A nested study was conducted on a subset of the peer- review claim data that represented a “monitored” peer-review process An Evaluation of the Effectiveness of Using a Prospective Peer Review where the payer was provided monthly reports on the status of all physical therapy claims in terms of the number of recommended visits. This information was used by the payer to monitor the case management process and ensure that the peer review recommendations were integrated into the medical management of the claim. Monitoring the review recommendations resulted in a reduction in the average number of visits from 13 to 8.5 visits per claim. The study results indicated that simply providing prospective peer- review may not control excessive physical therapy visits unless the information is integrated into the medical management of the claim.
Compensable Sunshine, Revisted
Our blog last week linking skin cancer to workers comp has already generated a few comments. "Workers comp attorney" raises some interesting questions:
(1) How much weight do you give to the person's leisure activities and/or length of employment? It seems these would certainly be factors in assessing whether the employment is the predominate cause.
When assessing the work-relatedness of skin cancer, claims adjusters will look carefully at non work exposures: hobbies such as hiking, fishing, boating, outdoor sports, surfing, swimming or simply tanning. Balanced against these exposures will be the work setting: outdoors all the time (eg, roofing, migrant farm work, paving) or just incidentally (framing carpentry).
While the case law is still rather limited, there are examples of compensable skin cancers involving a limousine chauffeur (!) in New York and an architect in Texas. [NOTE: a sun screen manufacturer, unsurprisingly, is keeping close track of case law developments!] It is safe to assume that the burden of proof remains on the employee to show that the cancer is work related, but this burden is now supported by substantial medical evidence. Indeed, the existence of government funded education on the risk - here is a CDC link - would tend to support claims of compensability.
As far as length of employment goes, it usually does not matter. As in the case of repetitive motion injuries, the most recent employer is usually on the hook for coverage, even if the employee has only been working for a few weeks.
(2) What steps could employers take to prevent work-related skin cancer other than the mentioned provision of sun screen and policies to enforce dress code?
Employers should just stick with the basics: provide - and enforce the use of - sun screens; require head gear. In the vast majority of exposed workers, this is not happening. There is research showing an increase in skin cancers among Latinos. I wonder if this is related to the negative cultural images associated with protective gear. [NOTE: my teenage daughters hate my wide-brimmed sun hat. It's just not cool!] [I wear it anyway.]
(3) What about research indicating that some, if not all, sunscreen products are carcinogenic?
While there is some evidence that tanning booths may be associated with cancer, I am not aware of any medical evidence to support a connection between sunscreens and cancer. In any event, the risk of not using a sunscreen far exceeds the risk of using one.
4) What balance should be sought between skin cancer and heat-related illnesses (if any "balance") as far as prevention is concerned?
Skin and heat protection are not mutually exclusive. People have been covering up in desert cultures for centuries by wearing light colored, loose clothing and head gear. (I hardly need add that American workers would vehemently reject any protective measures that made them resemble middle-eastern sheiks!)
Proactive, Reactive, Inactive?
Another reader wonders how many companies have actually implemented the recommended preventive measures. That's a great question. Judging by limited observation of workers in the sun, smaller employers have done little if anything to prevent risk. Any time I see a worker in the hot sun, shirtless and hatless, I assume that the cancer issue is simply being ignored.
What, if anything, will mobilize employers to take action to limit sun exposures? It usually comes down to money. Employers who operate in states that view skin cancer as potentially work related will eventually find it cheaper to provide (inexpensive) sunscreens and hats to their workers in the great outdoors. If state courts reject these claims, the workers will bear the burden.
Let's hope that employers take action before the courts force the issue. We have a known risk and we have proven remedies. Reason says that employers, at a minimum, will immediately share this information with exposed workers. But then again, how often is the voice of reason heard in the American workplace?
Working Outdoors: Skin Cancer and Workers Comp
With the full heat of summer bearing down on us, the Insider has deputized its readership to become informal safety inspectors: the next time you leave the office, observe any people who are working outdoors. Your checklist should include the fundamental safety drill: fall protection for height exposures; personal protective equipment such as hard hats, work boots and goggles; secure scaffolds and ladders; proper use of machinery (lawnmowers, clippers, circular saws, etc.); proper lifting and efficient material handling.
Here is a safety issue that you are likely to observe in the breach: protection from skin cancer. Exposure to the direct rays of the sun, especially at midday, is a significant safety hazard. Alas, when most people labor in the full sun, they usually take action against the heat, at the expense of protecting themselves from the sun's rays.
Cancer prevention dictates the wearing of long-sleeved shirts, a hat with neck flaps, sunscreen for exposed skin and sunblock for the nose and lips. When was the last time you saw a landscaper, carpenter or roofer dressed appropriately? When the heat rises, the shirts tend to come off. Bandanas and "do-rags" - considered cool in working circles - keep sweat out of the eyes, but they do little to protect the skin from the sun's rays. Hats with flaps? Dude, you must be kidding. Goggles and hardhats? They are the first to go when the heat rises.
As for the advice to "avoid exposure between the hours of 10 am and 2 pm," that is simply not going to happen. There is work to be done and those are prime hours for doing it. Siestas might be culturally acceptable in the tropics, but in our productivity-driven culture, siestas are not an option.
The Compensability Conundrum
As we have pointed out in prior blogs, the connection between work and occupational disease is often difficult to prove. With the exception of public safety employees, most workers face formidable odds in collecting comp for occupational diseases. There often are factors that mitigate against the acceptance of a claim: family history, smoking, fair skin, etc. Workers must be able to prove that workplace exposures are the "predominant cause" of the cancer. Sure, a laborer is under the sun at work; but he or she might also have significant exposure during leisure time, going to the beach, fishing, or just working in the garden.
It's always interesting to see how state legislatures translate emerging hazards into proposed legislation: lawmakers tend to react in a limited, ad hoc manner. See for example this proposed bill in the New York legislature:
This bill would provide,with respect to active lifeguards employed, for more than 3 consecutive months in a calendar year, by certain local agencies and the Department of Parks and Recreation, that the term "injury" includes skin cancer that develops or manifests itself during the period of the lifeguard's employment. This bill would further create a rebuttable presumption that the above injury arises out of and in the course of the lifeguard's employment if it develops or manifests during the period of the employment.
Note that the symptoms must develop during employment: this in itself may prove problemmatic, as many cancers occur some time after the direct exposure. Beyond that, the bill establishes a compensability presumption for one very limited class of workers, lifeguards. It does not address the myriad workers who face similar hazards on a daily basis (even if their work uniforms involve more than just a bathing suit).
Despite the fact that many workers will develop skin cancers which are likely to be work related, the number of compensable incidents will remain modest. The comp deck remains stacked against workers in the general area of illness.
Compensability and safety are two separate issues. We may not be able to do much about expanding coverage for work-related cancers, but we can take aggressive action to prevent them. It all comes down - as it does so often - to management: do you tolerate your workers's ad hoc efforts to combat the heat, or do you enforce "best practices" in cancer prevention. Do you make sunscreens and head protection readily available on the jobsite, or do you allow your workers the "individual freedom" to do as they please?
We all know how most managers respond. They take the path of least resistance. The risk of an accident is one thing, the seemingly remote risk of illness is quite another. It will take many more tragic cases of work-related cancers before a true prevention mobilization takes place. For workers struggling under today's galring sun, we can only hope that a word to the wise is sufficient.
Cavalcade of Risk; our Twitter debut; a few good blogs
Hot off the presses - Richard Eskow has posted the most recent edition of Cavalcade of Risk. He's got a good round-up of risk-related posts, but he had hazardous duty posting it due to a huge number of spam submissions. Spammy, fly-by-night blogs seem to be proliferating, grrr. Guess that is one of the risks inherent in business blogging.
In other news ...
We've just joined the rank of Twitterers - just getting our feet wet so far, but check us out twitter.com/workcompinsider. Twitter seems to be a love it or hate it type of thing for people ... some critics go to pretty creative lengths to weigh in with their opinion.
A few good blog finds this week to add to your reading list:
Risk Management Monitor - the official blog of Risk Management magazine, providing daily stories, commentary, interviews, podcasts and videos related to the world of risk management and insurance. Meet the bloggers.
And two international entries:
Ramazzini - a blog on work and health by Annet Lenderink, trained occupational physician and a journalist, who works as coordinator of knowledge dissemination at the Netherlands Center of Occupational Diseases. The blog is named after the Italian founder of Occupational Medicine Bernadino Ramazzinni (1633-1714).
Safety At Work Blog - an Australian blog focusing on news and opinion on important workplace safety issues. The blog was founded by workplace safety consultant and Kevin Jones. Meet Kevin and the other blog contributors and you can also follow them on Twitter.
Collision course: the potential impact of Chrysler's bankruptcy & sale on state workers' comp systems
Roberto Ceniceros of Business Insurance has been tracking the potential impact that a Chrysler bankruptcy and sale could have on state workers comp systems. In a story last week, he reports that Michigan Attorney General Mike Cox has taken legal action to protect the state. Cox stated that Michigan's Self-Insurers' Security Fund could face insolvency as a result of Chrysler's bankruptcy and sale.
Now, Ohio state officials are raising concerns about how the Chrysler sale could affect Ohio's workers comp system. This week, Ohio's Attorney General Richard Cordray has filed a "limited objection" to the pending sale. "While Chrysler’s bankruptcy filings show the automaker is committed to fulfilling its workers comp obligations, the filings do not hold a new owner to the same conditions, the attorney general said." According to a news report in Columbus Business First, there are about 5,000 Chrysler workers in the state.
It is likely that this issue is on the radar screen for other stat attorneys general, too. Ceniceros states that, "As of Dec. 31, Chrysler had 38,257 U.S. employees. It purchases workers comp insurance in some states while self-insuring in others, according to various state regulator databases."
And beyond Chrysler, there is the matter of whether General Motors is another likely candidate for bankruptcy - many expect this to be the case - see key dates in GM run-up to bankruptcy deadline. GM is a much larger company so problems could be multiplied, a matter that we discussed in our December posting about Maryland officials monitoring GM solvency related to workers comp.
Albania Deleon: Death in the Classroom
Albania Deleon is a entrepreneur. A legal immigrant and naturalized citizen from the Dominican Republic, she founded and operated Environmental Compliance Training (ECT) in Methuen, Massachusetts, the largest asbestos removal training school in New England. Between 2001 and 2007, she trained over 2,500 people in the intricacies of asbestos removal. Except that she didn't. Instead, she would fill out tests for certificate applicants and enter a passing grade. For $400, the (usually undocumented) worker was handed a certificate and then placed in a job through Deleon's other enterprise, Methuen Abatement Staffing. Her temporary workers handled hazardous abatement jobs throughout New England. (You can read the sorry details in a fine article by Beth Daley of the Boston Globe here.)
By the way, the training involves a total of 32 hours - not much of an investment in a life or death matter. (Some ECT students paid $350 and actually completed the training; for an additional 50 bucks, you could skip the training, pocket the certificate and get right to work, earning upwards of $15 per hour.)
ECT "graduates" went in to hundreds of schools, hospitals, churches, libraries, and homes throughout New England to remove asbestos. Most of them had no idea what they were supposed to do. Now there is deep concern that the workers, mostly young men from Central America, breathed the fibers, which can lodge in the lungs and lead to death decades later. Most had no idea how to properly wear a respirator.
In addition to their own exposure, these workers may have exposed their families to the cancer risk. Asbestos workers, if not properly trained, can inadvertently carry the fibers home on their clothes or hair.
More than a third of the 12,750 asbestos worker licenses and renewals issued in Massachusetts between 2002 and 2007 went to ECT "graduates." In New Hampshire, it was more than two-thirds.
In November 2008 Deleon was convicted on 28 felony counts. Shortly before her sentencing, she wrote a rambling, hand-written letter to the sentencing judge. Among other things, she wrote:
"I pray that God will forgive my soul and allow me to atone the rest of my life repaying and repairing the harm I have done. This is my solemn promise...I commit myself to work ceacelessly [sic] to make restitution to the government and to the keeper of my soul until I draw my last breath life (sic)."
The reference to "last breath" is especially ironic, given that many of her "students" - along with innocent family members - will suffer excruciatingly painful deaths, as their breathing slowly and inexorably shuts down.
Facing more than 7 years in prison, Deleon skipped town. There is a warrant out for her arrest. Oh, she abandoned her 3 year old son in the process. Alas, it appears that "the keeper of her soul" doesn't have a whole lot to work with...
Health Wonk Review: the biweekly smorgasbord of the best fare in the health care policy blogs
Welcome to Health Wonk Review, our bi-weekly smorgasbord of the best that the policy wonks have dished out on some of the most noteworthy healthcare blogs over the prior fortnight. We have an extensive sampling of tasty and nutritious treats, with lots of brain food among the fare - so without further ado, we offer this week's buffet.
- The love fest at the White House with health care providers generated great headlines, but, where's the beef? Merrill Goozner at GoozNews points out that the promises made by the trade associations and physicians held not a few ironies: Just Don't Ask CBO To Score It.
- To say that Joe Paduda of Managed Care Matters is skeptical about said love fest is an understatement. He is shocked and blown away that the politicians in Washington actually believe the health care-insurance industry's self regulation will reduce the nation's health care costs.
- Will the consortium of private sector stakeholders be able to cut $2 trillion in healthcare costs as they claim? Jason Shafrin of Healthcare Economist casts a critical eye on this in his post Letter to Obama: We're gonna save $2 trillion .
- When it comes to financing health care reform, Anthony Wright of Health Access WeBlog suggests that policymakers take a two birds with one stone approach by seeking options that not only raise funds but also help the health system.
- Are hospitals really taking a hit from the current health care system? That's a question posed by InsureBlog's Henry Stern, who deconstructs the latest survey results from the American Hospital Association in his post, Economy Tanks; Hospitals, Patients Hardest Hit.
- Brady Augustine of MedicaidFrontPage posts about Wellcare being taken to the woodshed for the sins of its prior executives who lived high on the hog while shortchanging vulnerable citizens. He discusses lessons learned, offering his thoughts on how to avoid such a scenario in the future.
- How Hard Can It Be To Coordinate Care? Rich Elmore of Health Technology News interviews Dr. Mai Pham, who turned up some startling results in a study of the number of physicians and practices that are linked to a primary care provider for coordination of care.
- Jeffrey Seguritan looks at a study of Medicare's unplanned hospital readmissions at nuts for healthcare, noting that readmissions seem to indicate low quality of hospital care and drive health spending. He suggests that hospitals should be incentivized to cut readmissions, but current policy proposals should be wary of system-gaming and should consider illness severity.
- Yikes. David Harlow of HealthBlawg posts about the Virginia prescription record security breach, in which millions of prescription records were lifted from a state government website and replaced with a $10m ransom note. He suggests that organizations that hold electronic protected health information should use this incident as a learning experience for planning and executing programs yo increase data security, as well as preparing for communications both to prevent breaches and to respond to any breaches that do occur.
- Roy M. Poses of Health Care Renewal has frequently tackled the topic of conflicts of interest in health care, offering examples of published defenses based on logical fallacies. Most examples were written by people who had their own ties to health care corporations and appeared mainly in the op-ed pages of newspapers, but in his post Attacking "Crusaders" Against Conflicts of Interest with Logical Fallacies, he offers an example in a scholarly journal, published as an anonymous editorial. He says we can expect to see more accusations of witch-hunting, prudery, moralism, lack of realism, and the like leveled against those who oppose such lucrative financial relationships.
- Louise of Colorado Health Insurance Insider posts about how Reid is absent in Sick Around America, apparently fallout with Frontline after last year's acclaimed Sick Around the World. Louise offers the scoop on the controversy.
- At Disease Management Care Blog, Jaan Sidorov examines the ugly politics that emerged around the issue of using gender in health insurance underwriting in his post Snatching Humiliation From the Jaws of Compromise.
- President Obama recently spoke about his grandmother's death and the questions it raises about end of life care in an interview published in the New York Times Magazine. Joanne Kenen of New Health Dialogue discusses Obama's Grandmother and the National Conversation on Healthcare, adding her own patient-centric questions that need to be part of the dialogue.
- Jocelyn Guyer of Say Ahhh! tells us that there was mostly good news for children in the Senate Finance Committee's Health Reform Proposal.
- Glenn Laffel of Pizaazz discusses a particularly vexing clinical and policy problem involving a defective defibrillator produced by Medtronic, that is currently in the bodies of a quarter of a million people. Leaving the failing device in place may kill patients, but removing it may do the same.
- Pop goes the health care bubble? At the Health Care Blog, George Lundberg looks at Enron, the dot.com era, and the real estate-financial collapse, all recent examples of growth and expectations far exceeding substance, and makes the case that the health care bubble will be soon to follow.
- David Williams of Health Business Blog asks why employees should be penalized for smoking or being overweight but not for having unprotected sex with multiple partners in his post on the ethical considerations of financial penalties for unhealthy behaviors.
- Eric Turkewitz of New York Personal Injury Law Blog notes that doctors still top our the pay charts, but complain about malpractice premiums anyway. He cites a survey which states that out of the ten top paying jobs, nine go to medical professionals.
- Tinker Ready of Boston Health News posts about a new Partners/Harvard HIT blog on clinical informatics. Incidentally, Tinker will host the next issue of Health Wonk Review.
- In his post Even more 'Fierce', Neil Versel of Healthcare IT Blog discusses a new publication FierceEMR, which includes one of his articles about live video links from ambulances to a trauma center in Tucson, Arizona.
- Although the influenza A (H1N1) or swine flu outbreak is gradually falling out of U.S. news headlines, Kara Rogers of Britannica Blog notes that the full extent of the outbreak may not be known for some time because other countries are only now experiencing their first cases or are experiencing an increase in confirmed cases as their backlogs of samples are tested.
- Is our food policy behind the current swine flu pandemic? Eric Michael Johnson discusses how we can best promote national health by changing how our food production policies at The Primate Diaries.
- And here at Workers Comp Insider, we've noted that there's a new OSHA sheriff in town. Long-time worker safety advocate and former safety blogger extraordinaire Jordan Barab is serving as Acting OSHA Administrator.
Noteworthy blog and Twitter finds
We surf the web so you don't have to! From time to time, we like to bring your attention to some new or noteworthy blogs related to workers' comp, healthcare, or other work-related matters. Now we're finding some Twitter feeds, too. Here's our current crop:
Judge Tom Talks - Judge Tom Leonard is one of ten judges at the Oklahoma Workers' Compensation Court, and in his blog, he offers his thoughts about issues affecting the efficient handling of claims. Congrats to Judge Tom for recently passing his one year "blogiversary."
MySafeWork Blog is the blog of Canadians Rob Ellis and Jessica Di Sabatino, who lost a son and brother to a workplace accident in 1999. David was only 18 when he died and his Dad and sister have been devoted to educating young workers - as well as parents and employers - about the importance of workplace safety related to youthful workers.
New Englanders and those interested in healthcare should take note of Boston Health News, authored by Tinker Ready. She is a health care journalist who has covered health and science news for a variety of notable publications, including The Boston Globe, The Washington Post, the Los Angeles Times, and Esquire, to name a few. We discovered her blog through Health Wonk Review, which - incidentally - we are hosting here tomorrow!
We note that NIOSH has a Twitter feed. Not sure how long the National Institute for Occupational Safety and Health has been tweeting, but it has been a useful format for disseminating news about the H1N1 outbreak.
SafetyNewsAlert - edited by Fred Hosier, this site is more of an e-zine than a blog, but has useful articles, news, and links on various workplace health and safety issues.
Lloyd's has several bloggers now, all accessible from the Lloyd's blog page.
Texting and Driving: Dying to Communicate
Aiden Quinn is 24 years old. He drives a trolley for the Mass Bay Transit Authority (MBTA or T) in Boston. He has a mediocre driving record, with three speeding violations (while operating a motor vehicle). Last week he was driving a trolley underground between Park Street and Government Center. He was texting his girlfriend, when he ran a red light and crashed into another trolley stopped in front of him. Over 40 people were injured, including Quinn. The T was shut down for hours.
Quinn has been fired - no surprise - and the T has now issued a policy prohibiting drivers from carrying cell phones. (I'm sure that made the other drivers real happy with their former colleague.) The 40 injured passengers are going to have numerous avenues for lawsuits, including: negligent hiring/negligent entrustment (should Quinn have been operating the trolley in the first place?); and negligent policies (they only prohibited cell phone use after the accident). We can assume that the T will settle as quickly as possible. This case is a real loser.
The larger policy implications are intriguing. It is safe to assume that any employee in the course and scope of employment who tries to text while driving is opening a huge liability for the employer. Texting is even more dangerous than talking on a cell phone: after all, you have to look at the screen to read a message and at the key board to reply.
[Aside: my teenage daughter assures me that her friends can text behind their backs without looking at the keyboard. This might work in class, but not very well on the road: "Look Ma, no hands on the wheel!"]
[Second aside: speaking of Ma, for a truly appalling (YouTube) video of a teenager who texts over 5,000 times a month, often while driving, check this out. If you can explain the passive "what can you do?" attitude of the mother, please explain via our comment section.]
Employers are caught in a bind: they are virtually compelled to issue policies limiting cell phone use and texting while driving, even while they recognize that some of their best and most productive employees are multi-taskers who routinely operate this way.
Which brings us to the sad story of Phyllis Jen, a talented internal medicine specialist at Brigham and Women's Hospital in Boston. Jen was driving her 2007 Toyota Prius when she drifted over the center lane at 6 pm (in full daylight). She crashed into another vehicle and was killed.
Police say it did not appear speed or alcohol played a role in the crash, but they were investigating whether Jen was using her Blackberry. Jen was famous for always being available, always willing to go the extra mile. Alas, she has abruptly and tragically run out of miles to go.
As companies struggle to integrate new technologies into safety procedures and as public officials struggle with whole new categories of risk, one thing is certain: the ubiquitous cell phone and related texting have taken a firm hold in our professional and personal lives. We just cannot seem to function without them. The problem is, in making ourselves available 24/7, we put our own lives and the lives of strangers at risk. Sure, we have important things to communicate. But on the scale of life itself, virtually all of these communications can and should be put off until time and circumstances allow. We might be dying to communicate with a colleague or friend, but it's certainly not worth dying for.
Cavalcade of Risk and some quick links
Joe Kristan is hosting the latest edition of Cavalcade of Risk at his Tax Update Blog. Unsurprisingly, swine flu is a common themes in this issue - but there's a grab bag of other risk-related topics, too - check it out!
Other links of note:
May is Electrical Safety month. OSHA resources on electrical safety
Does a focus on employee wellness pay off? The Wellness Calculator will help you to evaluate potential savings.
Dissecting Fraud - a podcast from Legal Talk Network. Host Alan S. Pierce discusses employer fraud with his guest Attorney Michael I. Fish.
Various newsfeeds on Swine Flu - a good resource to keep you up to date on any developments.
A Firefighter Fights Back
Over the past year, we blogged about a couple firefighters who abused the workers comp system. First there was the muscular Albert Arroyo, a Boston firefighter who participated in body building competitions, while collecting comp for a work-related disability. (Due to adverse publicity, he eventually lost both his job and his disability pension.) Then there was triathlete Christina Jijjawi, who parlayed a thumb injury into temporary total disability, during which she swam, cycled and ran for glory. Yes, I know, she was simply having an exceptionally good day.
Albert and Christina give firefighters a bad name. So it's a pleasure to introduce you to Scott Miller, an apparatus operator with the LA fire department. He not only restores the good name to firefighters; he is an inspiration to any and all who believe in returning injured workers to productive employment.
Answering the Call
Seventeen years ago, in the middle of the Rodney King riots, Scott was racing toward a fire when a vehicle pulled along side his hook and ladder truck and fired a handgun. A bullet entered Miller's cheek angled down through his body and severed a carotid artery in his neck. Given the quick response of his fellow firefighters, doctors were able to save his life, but a blood clot on the brain had left him paralyzed on the left side and unable to speak. (By the way, the shooter got 16 years - a bargain, considering that Miller "got" life.)
Miller was in rehab for over a year. He overcame the speech and many of the mobility problems, but never recovered fine motor skills in his left hand. He knew he could never do the physically demanding work of fighting fires, but he was determined to make it back to work. So he joined the Fire Prevention Bureau, where he eventually became a captain in charge of a crew that inspects commercial buildings.
He says of his prevention role: "It's an area of work that I've come to respect. I realized that I had to move on and refocus on the more important things of life, that I can't drag my dream with me until it becomes a nightmare ruining other positive things in my life."
One of the ironies of this story circles back to Albert Arroyo. He, too, worked in the prevention bureau, but he used the excuse of a questionable injury to go out on disability, so he could pursue his dream of winning a body-building competition. Scott Miller's dream was a little simpler and much more moving: he just wanted to be a firefighter again.
Barab signals OSHA changes, heightened enforcement
We recently announced Jordan Barab's appointment as Acting OSHA administrator and, as expected, he is losing no time in making changes. Last week, he testified at a hearing held by the Subcommittee on Workforce Protections of the House Committee on Education and Labor, outlining some immediate OSHA changes. These include:
- the addition of new inspectors under the American Recovery and Reinvestment Act of 2009
- formation of Severe Violators Inspection Program (SVIP). This is a reformulation of the Enhanced Enforcement Program (EEP), which will step up inspections and enforcement of large companies with repeat OSHA violations
- the intent to work more closely with the Department of Justice to prosecute serial safety violators
- a new National Emphasis Program of specialized inspections focusing on flavoring chemicals (diacetyl)
- a suspension of establishing goals for new Voluntary Protection Program sites and Alliances so that more resources can be put on enforcement
Lisa Mascaro also discusses the shift to a more aggressive OSHA in the Las Vegas Sun. She notes that various either have been introduced or are expected to be introduced that would strengthen penalties for employers with serious or repeat safety violations and add a new criminal felony category.