Coordinated Health Care: Now There's An Idea!
For the last 3 or 4 years, I've been privileged to be a Trustee at Commonwealth Care Alliance, a Massachusetts non-profit HMO serving dual eligible elderly poor. In this case, "dual eligible" means people who qualify for both Medicare and Medicaid. CCA does great work, but it's always swimming upstream. It gets reimbursed by increasingly low and lower Medicare and Medicaid payments. And let's face it, the elderly poor do not constitute an influential political constituency.
One of CCA's founding Board members is Rob Restuccia. In the early 1990s, Rob founded Health Care For All (HCFA), a non-profit health care think tank and advocacy organization devoted to creating a "consumer-centered health care system that provides comprehensive, affordable, accessible, culturally competent, high-quality care and consumer education for everyone, especially the most vulnerable." You see, Rob believes health care is a basic human right, not a privilege for those who are lucky enough to be able to afford it -- a position with which I wholeheartedly agree. HFCA was a central player in the successful effort to pass the Massachusetts Health Care Reform Plan, which, to date, has brought health care to 97.4 percent of its citizens. Universal coverage is a reality in Massachusetts, albeit a more expensive one than originally thought.
The founders of HCFA and its public interest and very influential law firm, Health Law Advocates, are the alumni who came out of the Dukakis Administration and who continue, with lance in hand, to attack the biggest windmills they can find, and, as the Massachusetts Commonwealth Connector proves, those lances are still sharp.
Rob now runs Community Catalyst, a powerful, grass-roots, national non-profit, active in more than 40 states and dedicated to bringing affordable, quality health care to everyone in America. You've probably never heard of it, but I assure you that the dealmakers on Capital Hill are well-aware of Community Catalyst.
As I have written before, health care within worker' compensation, at only two to three percent of total health care spending, is the tiny caboose on the back of the great big group health locomotive. But workers' compensation medical costs have increased at roughly twice the rate of group health annual increases for a dozen or more years, and most experts agree that the biggest engine fueling the constantly rising comp medical costs is over-utilization, which itself is driven in large part by a lack of coordinated care.
Rob Restuccia's Community Catalyst has just published a white paper on Coordinated Care, Special Delivery: How Coordinated Care Programs Can Improve Quality and Save Costs. This paper does not focus on coordinated care within workers' compensation. Its logically larger aim is to influence care in the other ninety-seven percent of medical spending. However, the absolutely common sense points it makes and lessons it preaches can, and I suggest, should be applied to the world of workers comp.
It deserves to be read by everyone involved in the current health care debate.
Health Wonk Review's Confederations Cup Edition
The most recent edition of Health Wonk Review - the Confederations Cup Edition is freshly posted at Jason Shafrin's Healthcare Economist. Where else can you get the week's highlights of soccer and health care policy all in one place? Quite appropriate because as the health care issue heats up, the debate is getting to be more and more like a contact sport. Keep score with posts from the blogosphere's best & brightest health care policy wonks.
Fire sale - Want to buy a book of workers comp business? Ante up your billion dollars and it may just be yours. According to a story by Patricia Anne-Tom In Insurance Journal, Gov. Arnold Schwarzenegger is proposing to sell a portion of California's State Compensation Insurance Fund. The SCIF wold remain as the insurer of last resort.
Summer reading - We are happy to learn that Risk Management Magazine recently began offering free online access to their excellent publication. May and June issues are now available online. And as we've previously mentioned, you should also check out their blog, Risk Management Monitor.
And for another free read, the School of Business Law, Curtin Business School of Perth Australia has announced that the first edition of The International Journal of Social Security and Workers Compensation is published and can be downloaded at no charge. This is an online double-blind peer-reviewed journal which focuses on strengthening international discourse in the areas of social security and workers compensation, including the provision of disability support. The publication is edited by professors Robert Guthrie and Marius Olivier.
PTSD - Dispelling the Myths About Post-Traumatic Stress Disorder (PTSD) & Other Psychological Health Issues - about 8% of the U.S. population (approximately 24 million people) will develop PTSD at some point in their lives. Among military veterans, PTSD is quite common. Approximately 30% of Vietnam War veterans experience PTSD over the course of their lifetimes, and recent data compiled by the Rand Corporation suggest that approximately one in five service members who return from deployment operations in Afghanistan and Iraq have symptoms of PTSD or depression. Learn more about the myths associated with PTSD and review common employment questions.
Forensic accounting - How are property, casualty, and fidelity claims being influenced by the credit crisis? In an article in this month's issue of Claims Paul McGowan discusses the role that forensic accountants are playing during the credit crisis.
Barnyard animals, gang members and comp - In a recent post on his blog, Roberto Ceniceros reminds us of the vast array of work-related issues that workers comp addresses - including such wildly disparate issues as gang shootings and farm animals run wild.
More on the UCLA lab death of Sheri Sangji
Chemical & Engineering News has a followup story on the UCLA lab fire which killed Sheri Sangji in December 2008. The University of California, Los Angeles has paid the OSHA fine but is appealing the state's findings of workplace safety violations. According to the article, UCLA's vice chancellor for legal affairs, said the university's appeal was necessary to ensure "that there was no citation or finding that can be used against the university in any future proceeding."
We recently profiled the Sangji case, echoing some of the preventive measures suggested by the original article. Our post drew some push back in our comment section. Chemjobber disagreed with our recommendation and pointed to an article he wrote disputing much of the original article. (He has covered the Sangji case extensively over a series of posts so if the case interests you from either a science or a safety perspective, we've listed some of his excellent entries at the end of our post.)
Another commenter said "Certainly agree that suggestion to make safety records a key driver for tenure descisions is ignorant. Not to mention self-serving, when made by a "safety professional."
We had a chuckle at the use of the scare quotes on the term safety professional...but in this case, it is spot on. Just to clarify the record, nobody at Lynch Ryan is a "safety professional" and we don't make any money from providing safety services. In point of fact, if we really wanted to be self-serving about things, we would keep our mouths shut about safety because more frequent workplace accidents usually mean we make more money -- out-of-control workers comp costs are generally what drive employers to seek our consulting services. Despite this, we would happily see workplace accidents and injuries eliminated and feel confident we could find another business niche were that the case. Maybe we would go back to school and study chemistry!
Regardless, we don't think safety professionals should be lightly dismissed. We have seen other "exotic" workplaces involving science, medicine, and technology make their peace with safety standards and oversight and still be innovative and competitive. And in this case, if Cal/OSHA is correct, there was nothing particularly exotic about the safety procedure that might have saved this young worker's life. They cite the lack of a lab coat as the single most significant factor in the severity of the burns that led to Sangji's death. And as the C&E story notes, on a recent lab walk-through by union reps, people in the lab still weren't wearing lab coats.
Some workplaces come by safety voluntarily with a commitment from the top. Other employers - even generally well meaning employers - don't truly embrace safety until they have had paid some very steep price. Sometimes that price is a gut-wrenching human one, as when a worker dies; other times, the toll is purely economic, in high workers comp costs, ruinous lawsuits, and bad publicity. Unfortunately, money is often the best change agent. That, and the push provided by standards and enforcement under OSHA.
While the case under discussion involved a paid employee, many workers in academic labs are students so workers' comp generally doesn't come into play. We don't believe that making lab and worker safety standards a factor in tax-funded research and grants is a particularly radical suggestion. We would also favor safety being a line item in any performance reviews for professors who oversee labs as is often the case in private industry. Right now, the professor in the UCLA lab will likely suffer an enormous personal toll; we favor prospective and preventative measures over retrospective ones.
In any case, we thank our commenters for their opinions and we would point any interested readers to the fascinating comments that followed the original article in Slate's discussion forum. Students, scientists, private lab workers and safety professionals all weigh in, and as would be expected, opinions run the gamut. Some agree with much of the article citing a prevailing culture of bravado and a tendency to view safety as the "the redheaded stepchild" or "the scapegoat who took the fall when anything bad happened." Others see safety as the responsibility of the individual, with one prickly commenter going so far as to suggest that Sangji's carelessness was such that her death should have been labeled as a suicide. Yikes.
To follow this story as it develops, we refer you to Chemjobber. For those interested, here are some of his posts to date, with the most recent post at the top
Where is Sheri Sangji's notebook?: further details emerge in the UCLA/tBuLi case
Sheri Sangji update: recent articles
Expectation": more details emerge about the UCLA/Sheri Sangji case
Patrick Harran, peeing in the jury pool?
Critiquing the LA Times Sangji article, etc.
What happened to Sheri Sangji?
At least nine people were killed yesterday when a Red Line Metro Rail train crashed into an unmoving train. Washington D.C. trains are equipt with the latest fail-safe technology. Accidents are not supposed to happen: trains are controlled by computers, which theoretically prevent any two trains from occupying the same space at the same time (the textbook definition of an accident).
Something failed yesterday. The key player in determining the cause was the second train's driver, Jeanice McMillan, 42. She died in the crash.
The accident occurred in full daylight. The first train had stopped due to traffic ahead. The second train, traveling at high speed while rounding a slight curve, crashed into the stationary train: the brakes had not been applied. We may never know what McMillan was doing at the time of the crash, but we can guess that she either was not looking ahead or was too panicked by what she saw coming.
It is too early to point fingers, but Metro officials have already singled out McMillan. A Metro source said McMillan was "relatively inexperienced", ranking 18th from the bottom on the seniority list of 523 train operators. She had been a Metro employee since January 2007. Train operators must first operate a bus for a year before they can apply to operate the train. They then receive about 12 weeks of training. Among the many things we will learn in the coming weeks is just how effective that training program is.
The Operator's Passive Role
Lyndsey Layton, a Washington Post staff writer, describes how the system is supposed to work:
The trains in yesterday's crash were supposed to be in automatic operation, which means the operators would have been relying on the computerized system to run the trains. The only function required of a train operator during automatic operation is to close the doors after a station stop.
This raises an interesting issue: if computers operate the trains, how much attention on the part of the driver is required? With little to do between stations, drivers may tend to "zone out" because they don't have to pay as close attention as they do when running trains manually. The computerized system creates a false sense of security.
Four years ago the signal system briefly failed in the tunnel between Foggy Bottom and Rosslyn, forcing a quick-thinking operator to stop his train manually to avoid a crash. The operator of one train noticed that he was getting too close to the train ahead. The signal system was telling him the track was clear, but he hit the brakes anyway. For reasons that we may never know, McMillan was unable to do this yesterday.
The problem may lie in the concept of a system that cannot fail. Ultimately, no mechanical system can be totally fail-safe. Perhaps DC needs to re-evaluate the role of drivers and figure out a way to keep them more actively involved on a moment-to-moment basis. We are all lulled into a false sense of security by the technical wonders that surround us. As yesterday's crash demonstrated, that security might be an illusion.
Risk Transfer without Risk
The Defense Base Act (DBA) was enacted in 1941, to cover the injuries to civilian employees - primarily a few hundred engineers - during the second world war. The act might have worked then, but it certainly is not working now, nearly 70 years later. As we have blogged in the past, the DBA is a boondoggle, generating huge profits for a small number of insurance carriers and routinely devastating both the civilian workers wounded or killed in war zones and their families. There are over 10,000 claims filed each year: the medical only claims are usually paid; the indemnity claims are dissected, inspected, detected, and ultimately, rejected. A handful of insurers (AIG, CNA among others) are making big bucks at the expense of the wounded and the dead.
NOTE: As bad as the situation is for U.S. citizens wounded and killed in Iraq, it is far worse for foreign nationals.
The Domestic Policy Subcommittee of the House Oversight and Government Reform Committee held a hearing last week on the DBA. The title of the hearing betrays an (understandable) prejudice: "After Injury, the Battle Begins: Evaluating Workers' Compensation for Civilian Contractors in War Zones." The hearing focused on the handling of workers' compensation insurance for federal contractors working overseas, specifically on the inordinate delays in compensation running parallel to the enormous profits for insurers. Among those testifying were Deputy Labor Secretary Seth Harris; Timothy Newman, Kevin Smith and John Woodson, former civilian contractors in Iraq; Kristian Moor, president of AIU Holdings, Inc., a division of AIG; George Fay, executive vice president for Worldwide P&C Claims, CNA Financial; and Gary Pitts of Pitts and Mills Attorneys at-Law.
Kristian Moore defended AIG's decisions and motives, pointing the finger at a lack of Labor Department oversight and a system overtaxed with cases. "We are doing everything we can do," suggested Charles Schader, senior vice president and chief claims officer for AIU Holdings. Yeah, everything you can do to make money.
At the conclusion of the hearing, Dennis Kucinich (D-Ohio) warned AIG executives that he plans to demand copies of internal memos and documents that will link claims denials to the company's profits. Most of us do not get terribly excited by the prospect of reading claim files, but these will undoubtedly provide some compelling reading. While I doubt that the subcommittee will find a direct, written link between denials and profits, the rationale for the individual claim denials - in the face of compelling evidence of compensability - should prove riveting. Was it incompetence or was it greed? Something cruel, heartless and cynical took place in the back rooms of carriers with responsibility for civilian claims. If you like Edgar Alan Poe, you'll love the claims files of AIG and CNA.
Risky Job, Risky Work
Seth Harris, the new deputy secretary at the U.S. Department of Labor, is in charge of this mess for the government. He's been on the job for 3½ weeks. Congratulations on the new job, Seth! (You might want to keep your resume circulating.) Seth has been working less than a month, but he has already figured out that the system is in need of fundamental change.
The work of insurers usually involves risk transfer. Under the perverse incentives of the DBA, the risk is absorbed by taxpayers, the pain falls on civilian workers and their families, and the profits - running from 37 to 50 percent of premiums - are pocketed by the carriers. Risk without transfer. It's amazing that AIG can generate this level of profit in one division and still only trade at $1.40 a share. I guess that they have been looking for risk in all the wrong places.
Vintage safety clips - women in the workplace
In searching for some safety videos, we chanced upon these vintage clips about workplace safety for women and supervising women, which we pass along for your amusement and elucidation. We're happy to note that in the ensuing years, there have been significant advances for both women and for safety!
The Trouble With Women (1959)
Cavalcade of Risk #80 is posted; other news notes
Get your biweekly fill of risk-related blog posts - Rita Schwab does a great job in hosting Cavalcade of Risk #80 at her blog Supporting Safer Healthcare.
And in other news ...
Construction - According to the release of a report from the Workers Defense Project, Texas is the most dangerous state in the union for construction workers. In 2007, 142 Texas construction workers died, more than any other state. California ranked second, with 81 deaths. According to the report, surveys with more than 300 construction workers revealed that more than two-thirds of the respondents did not receive basic safety training before starting their jobs.
VA compensability - Jon quoted in WaPo - In February, my colleague Jon Coppelman posted about the case of a Virginia truck driver who was found by the side of the road laying by his truck and who subsequently died after lingering in a coma. Sunday, The Washington Post covered the story of Arthur Pierce quoting John and Workers Comp Insider about the attempt by Pierce's wife to change Virgina law related to cases like her husband's. Apparently, investigators who reconstructed the scene learned that Pierce fell about 12 feet and injured his head. If he had been found dead at the scene, the fatal injuries would have been presumed to arise out of employment, but due to a quirk in the Virgina law, that presumption does not extend to those who linger for a matter of time before dying, even if that time is just a few hours. So far, her efforts to change the law have been unsuccessful but she plans to try again in January.
Slim Jim Plant Explosion - Insurance Journal has a report that investigators at the scene of last week's North Carolina Slim Jim tragedy have determined that a gas leak caused the explosion and that the ATF has concluded the explosion was an accident and closed its criminal investigation.
NIOSH - Protect your family from take home toxins - report on exposures to substances such as lead, asbestos and beryllium, transported from the workplace to home.
Seasonal Safety - Florida AgSafe had a good library of safety articles and guidelines for agricultural workers - also, check out their Safety News and Notes newsletter, which is archived on the site or you can sign up to get them by mail.
White Man Quits Lousy Job
Back in April we blogged some of the formidable problems facing the obsolete, friction-ridden comp system in New York. Two years ago, Elliot Spitzer appointed Zach Weiss to clean up the mess, just as voters had chosen Spitzer to clean up the mess in Albany. As of last week, both Spitzer and Weiss had resigned their positions, albeit for different reasons.
Weiss announced that he is stepping down in order to become an administrative law judge, which he describes as a "higher paying and more secure job." Weiss will don robes for the Social Security Administration and issue rulings on disability cases. The onerous comp job paid a relatively paltry $120,800. The initial salary at his new job is $131,000.
Beyond the dollar difference, Weiss's new job entails making real decisions. What he says as a judge, goes. This will be in stark contrast to the job he just abandoned, where competing interests, deep pockets and decades of bitter rivalries have resulted in chaos and paralysis.
Weiss said of his new position: "It might seem like a step down for me. But it's really a good job. You have an opportunity to make a very consequential decision in people's lives." It pays more. People listen with respect. Your word is law. Gee, Zach, that's hardly a step down!
Back in April we linked Weiss's thankless task running New York's comp system to Barack Obama's challenges as the new president. The satirical news source The Onion announced Obama's election with the headline: "Black man given worst job in America." Well, by those standards Zach Weiss might have had the second worst job in America. Not any more.
Health Wonk Review - special health care reform issue
Joe Paduda has posted this week's Health Wonk Review: Health Reform - what's happening and why. It includes analysis and commentary from our usual participating policy experts - as well as guest commentary from Senator Byron Dorgan (D ND), chair of the Senate Democratic Policy Committee, who gives us his thoughts on the importance of reform and a window into the process.
Three workers were killed and more than 40 were injured in this week's devastating explosion at the ConAgra meat plant in Garner, North Carolina. According to medical authorities, several of the workers are being treated for burns covering 40 percent to 50 percent of their bodies; other suffered exposure to toxic fumes from ammonia leaks. Teams from the Bureau of Alcohol, Tobacco, Firearms and Explosives, the U.S. Chemical Safety Board and the Department of Labor have been dispatched to the site to begin investigations into the cause of the explosion. Via WRAL, survivors recount their experience. More on the explosion: The Pump Handle and Comp Time
NIOSH addresses health and safety issues related to green jobs, noting that "...for the product of work to be truly sustainable, the work itself must also be sustainable. It must protect not only the surrounding environment and its end-users, but also the workers who are producing it. Sustainability must include worker safety and green jobs must be safe jobs."
National Underwriter reports on a potential federal regulatory plan for insurance, which may be unveiled next week. Related: In this month's Risk Management, Lori Widmer asks if now is the time for the optional federal charter. For more background, see the Insurance Information Institute: Optional Federal Charter.
Will Health Care Reform Crush Workers Comp?
If health care reform is the proverbial 800 pound gorilla, then the medical portion of workers comp is a 15 pound Maine Coon cat: it might big for a cat, but compared to a giant gorilla, it is barely noticeable. Nonetheless, this cat is blessed with a very strong notion of what it needs. As the nation moves closer to universal health care, the implications for workers comp are both profound and troubling. Comp medical services comprise a mere 2% of total medical expenditures, so policy makers in Washington will be inclined to ignore its special needs. That could create profound problems for the employers, insurers, and state administrators who deal with comp issues.
There are a number of key reasons why reform of health care may undermine the ability of states to deliver a quality workers comp system. (We previously blogged these issues here, here and here.) In order to provide some focus for the pending debates, here is a brief summary of how comp fits into the overall medical universe:
The focus is similar but not identical
The general health care system focuses on the prevention of what can be prevented and the treatment of that which can be treated, up to limits of coveraged defined in specific health plans. The overall goal is to preserve the life and health of individuals and families. This system provides treatment from conception up to the moment of death.
The comp system has a much narrower focus: comp provides treatment only to workers who are in the course and scope of employment. Comp treats work-related injury and illness, with the specific goal of returning injured/ill workers to productive employment.
Eligibility is Radically Different
The general health system provides defined services to individuals and families. Virtually any illness or injury is covered, including many forms of mental illness.
Comp covers only what occurs during work and is proven to be work-related, with an almost phobic disregard for mental impairments.
The cost structures are very different
In general healthcare, the premiums for coverage are paid by individuals and their employers. Depending upon the plan, individuals and their family members assume at least some of the cost of treatment, through premiums, co-pays and deductibles. The trend has been to shift more and more of the costs onto the consumer (which, in turn, becomes an incentive to reduce utilization).
In comp, employees never pay comp premiums and are never charged co-pays or deductibles. Injured workers are covered from the first dollar. Thus, only the employer, self-insured or who purchases mandatory coverage, and the insurer have the incentive to control costs. No such incentive exists for injured workers.
There are Perverse Incentives in the Comp System
Under comp, injured workers are paid not to work (indemnity). They may not like their jobs. They may malinger, seeking treatment more often than medically necessary (no co-pays to discourage them), thus prolonging disability in order to avoid work. The incentives for returning injured/ill employees to work lie primarily with the employer (who pays the premiums or is self insured) and the carrier (who pays the bills, which may exceed the premiums collected).
For employees with minimal job skills and perhaps no job to return to, the incentive for remaining on comp as long as possible is powerful.
Comp is a State-Based Program
The new mandates for health insurance coverage will come from the federal government. Comp, by contrast, is strictly a state by state program. The new federal mandates (eg., employee choice of doctor) may well conflict with long-established systems.
Policy makers are trying to create a new paradigm for medical coverage in the twenty first century: truly, a daunting task. Ultimately, the new direction for health care will be driven by cost and coverage. Whether the providers are public, private or both, health care cost controls and rationing will lurk in the shadows: will there be a cap on total expenditures for any given individual and any given conditions? Will there be limits on end-of-life services? How much of the costs will be shifted to consumers? What incentives will be created to reduce utilization?
In stark contrast, comp is and will remain an early 20th century system, based upon an industrial world that no longer exists. It already provides virtually universal coverage for people who work. The costs belong exclusively to employers and carriers; there is no cost-shifting onto injured workers and there are no incentives for these workers to limit expenditures. The over-arching goals are returning injured workers to productive employment and providing lifetime benefits for the totally disabled.
So it all comes down to this: When and if the 800 pound gorilla that is universal health care actually sits down, will it be beside - or on top of - the comp coon cat? Will the federal mandates take into account the unique and idiosyncratic needs of the comp model, or will the new mandates inadvertantly crush the system, state by state by state?
There are often unintended consequences when well-intentioned humans try to solve gargantuan problems. Let's hope that the comp system does not fall victim to this fundamental law of human endeavor.
Suffering for Art
Alan Rosenbaum is a revered professor of art at Virginia Commonwealth University (VCU). He shows students how to work with clay - at least, he used to, until he was disabled by silicosis. Rosenbaum was exposed to silica dust in the clay mixing room and ceramic studios of the university. The state Workers Compensation Commission last year found that the professor's silicosis was caused by his exposure to hazardous dust and awarded him permanent disability benefits totaling $211,800.
Silica is a common mineral found in clay, sand and rock. The dust in the VCU's Fine Arts Building came from the powder that students and staff mixed with water to make clay, as well as from scraping kilns clean of bits of clay and glaze after firing. There are intake vents directly above the five mixing machines, designed to take in dusty air and run it through a filter before releasing it outside the building. However,the vents failed to function properly, because for five years university staff members taped plastic bags over them, apparently to keep the dust from spreading elsewhere in the building. (There were complaints from woodworking and other shops that the dust migrated from the intake vents into work areas.) By blocking the vents, all the dust was contained in the ceramics area.
In addition to the vents being blocked, janitors swept the floors daily, causing the dust to fill the air for thirty minutes or more.
The Hazards of Sand
Ironically, VCU art classes included instruction on the hazards of silica in clay. (Here is a fascinating, if somwhat bizarre MSDS sheet on sand. It might make you think twice about heading for the beach...) It is hardly surprising to learn that students and teachers ignored the warnings.
Air-quality tests conducted by VCU staff after Rosenbaum's diagnosis found dust levels were 98 percent below hazardous levels -- but VCU did the testing after removing plastic bags that blocked the ventilation vents. In addition to activating the vents, janitorial staff began using sweeping compound to capture fine particles before they were released in the air. In other words, mitigation of the risk was readily available, but such measures were not implemented until Professor Rosenbaum became ill.
As in Julie Ferguson's post last week on laboratory hazards, this situation in the art studio of a major university reminds us that education is not without risk. A little learning can quickly become dangerous. The budding artist working with clay and the mason cutting a cinderblock face essentially the same hazard. Dust is dust. If we are not careful, dust can speed our return to the dust from which we all come. That's one lesson that Professor Rosenbaum is unlikely to forget.
Death in the lab: why aren't university labs safer?
Earlier this year, 23 year-old research assistant Sheri Sangji suffered an excruciating death after having been engulfed in flames in a UCLA science laboratory. A drop of t-butyl lithium, a substance that ignites on contact with air, spilled on her clothing causing an instant conflagration. Sheri suffered second and third degree burns over 40% of her body. Beryl Lieff Benderly writes about Sheri's death in Slate, raising the question of what makes academic laboratories such dangerous places to work? Benderly notes that the safety failures that led to this fatality were unfortunately not an anomaly in private academic laboratories:
The death of a healthy young woman from a chemical spill at a UCLA lab is deeply shocking. But the presence of flagrant safety violations at a major research university is no surprise. After reading about the Sangji incident and others like it, a columnist for the peer-reviewed journal Chemical Health and Safety wrote that he'd come to the "disheartening conclusion that most academic laboratories are unsafe venues for work or study." Though no one keeps comprehensive national statistics on laboratory safety incidents, James Kaufman, president of the Laboratory Safety Institute in Natick, Mass., estimates that accidents and injuries occur hundreds of times more frequently in academic labs than in industrial ones.
In the wake of this accident, Cal/OSHA imposed a $31,875 penalty, citing safety lapses and lack of training. Benderly notes that had Sheri been a student rather than a paid technician, her death would not have been investigated by OSHA because the occupational health and safety laws that protect workers in hazardous jobs apply only to employees, not to students. The contrast between the culture, attitudes and practices of private laboratories and academia can be dramatic. Benderly describes an all-too-frequent academic machismo that can be disdainful of practices that would enhance safety, viewing them as bureaucratic and potentially stifling to academic freedom. In fairness, similar arguments and protestations have been raised by various private industry segments in response to OSHA standards, but the difference is in accountability. With most federal grants, "... applicants are routinely asked to document the steps they will take to safeguard the people and vertebrate animals they'll be studying, but they needn't provide any information on how they'll protect the experimenters themselves."
In another article for ScienceCareers, Benderly uses this incident as a springboard to discuss the issue of safety in academic laboratories in greater depth. In Taken for Granted: The Burning Question of Laboratory Safety, after examining various reports of the accident, she points to two areas that require attention, both in the UCLA lab, and frequently in other academic settings. These will be no surprise to safety professionals anywhere: better training and the need for a safety commitment that starts with the senior-most level of an organization. "The impetus to make safety a priority in academic labs must come from those able to enforce consequences."
She is right. There are rock star academics whose research can bring huge grants and critical acclaim to a university. Safety is generally not a criteria that is evaluated as a part of their record, but it certainly should be. Benderly makes a compelling case that federal funding sources and university officials need to add safety as a criteria of evaluation to foster a culture of safety that will protect researchers as well as the research subjects.
Cavalcade of Risk: 3rd Anniversary Edition, and other news briefs
Hank Stern is hosting Third Anniversary Edition of Cavalcade of Risk over at InsureBlog. Hank deserves a pat on the back and many plaudits for all the work he has done in founding and maintaining this carnival. While many contribute and host, he's the real heart and soul behind this operation - so many thanks!
New in the blogosphere...
In other news, we're happy to see Business Insurance has made its debut into the blogosphere. We've featured reportage by Robertos Ceniceros several times on our blog in the past and he now has a workers comp-focused blog called Comp Time - check out his post today to learn about the work-related risks of Fritos. We also call your attention to Joanne Wojcik's Benefits Beat - good stuff. There are several other topical blogs that might be of interest.
According to a recent article in Insurance Journal Andrea Ortega-Wells, Supreme Court Nominee Sotomayor Shows Record of Favoring Insurers. And on the same topic, we again call your attention to Michael Fox's excellent rundown of Sotomayor's opinions on labor and employment law.
To follow-up on the Chrysler bankruptcy-sale issue which we've previously discussed, Insurance Journal reports that Fiat has agreed to assume Chrysler's workers' comp liabilities in Michigan. According to the Detroit Free Press, Fiat has also agreed " ... to assume responsibility for workers compensation insurance in any states where the new company has operations, such as Michigan, Indiana, Ohio and Illinois."
Employment resources for people with disabilities - this guide from DisabilityInfo.gov has an excellent list of links to a variety of resources for jobs searches, job training, vocational rehab, and many other tools and support services.
Toxipedia is a good new-found reference site, which describes itself as "a wiki-website created to bring experts and lay people together to lessen the information gap between those with knowledge on environmental and public health and those that need the information to lead healthier lives." Among other site resource, they recently announced that they will be managing the National Library of Medicine's World Library of Toxicology.
RIMS recently announced that they'd recently re-launched their online RIMS Buyer's Guide, a directory of risk-related suppliers that can be searched by keyword, category and geography. It should be noted that these are paid listings.
Can You Terminate an Employee on Workers Comp?
Here's a question that comes up frequently in our employer seminars: can you terminate an employee who is on workers comp? In general, it's not a good idea. In many states there is a presumption that the termination is in retaliation for filing the comp claim. Nonetheless, the complete answer to the question is yes, you can, but you must do it very carefully.
The invaluable Risk and Insurance Magazine describes a case in Texas that illustrates this point nicely (Williams v AT & T, U.S.District Court, Southern Texas). Williams, a telecommunications tech, alleged that he sprained his leg stepping down from a ladder. He was a bit confused about the exact date, offering more than one in his descriptions of the incident. His claim was denied. One month later, he violated an important company policy and was suspended and then terminated. Even though his comp claim was denied, he alleged that he was terminated in retaliation for filing the claim. He sued AT & T for violating the Texas comp act.
Keep in mind, the employer must be able to demonstrate that the termination had nothing to do with the (denied) claim. In this situation, the burden of proof is definitely on the employer. AT & T presented evidence that Williams had a history of poor performance and excessive disciplinary actions for more than a year prior to the alleged injury. In other words, two key criteria of proof were met: the disciplinary problems preceeded the workers comp incident and they were thoroughly documented.
The court granted summary judgment to the employer. While falling under the protected class of employees who have filed comp claims, Williams could not establish that his termination was related to the comp claim. There were plenty of other reasons for the employer's actions.
I often hear employers complain that they had been planning to terminate a marginal employee, but then the employee got hurt. In most cases, there is inadequate documentation of poor performance prior to the injury. These employers are stuck: any attempt to document performance issues after the injury will be viewed sceptically by the court. The termination will trigger retaliation claims.
Here is a quick tip to avoid this situation: fire marginal employees before they get hurt. Once employees are injured on the job, an employer's options narrow significantly. Given that marginal employees are more likely to be injured - that's part of what makes them marginal - prompt action to end their employment is an essential "best practice."
Cell Phones: Unsafe at Any Speed?
We've been following the tentative steps taken by management to confront a relatively new and ubiquitous risk: the use of cell phones while driving. Most people seem to realize that cell phone use is a dangerous distraction, whether involving talking or, lord help us, texting. While surveys indicate that nearly every driver (98 percent) considers him or herself a safe driver (NOT!), fully 20 percent of drivers between 16 and 61 admitting to texting while driving and 80 percent admit to talking on their cells. What we have is a serious disconnect between risk and action. We are all just driving obliviously up DeNile.
We have focused our attention on the potential risks to corporations, who are liable for the actions of their employees "in the course and scope of employment." Back in 2001, Dyke Industries settled a case for $16 million, involving one of their salespeople taking out an elderly pedestrian while chatting on a phone.
Maggie Jackson in the Boston Globe writes that some corporations have taken aggressive action to mitigate the risk. Back in 2005, the engineering firm AMEC prohibited employees from any and all cell phone use while operating a vehicle. DuPont, a legendary leader in safety, first required employees to use headsets and then, on second thought, forbid all cell phone use while driving. AstraZeneca has similar policies in place.
What about everyone else? When, if ever, will managers of major and minor corporations bring the hammer down on blatantly risky behaviors behind the wheel?
We have two thoughts on the matter. First, it will take a few more tragedies to get the attention of corporate America on this risk. We all seem to labor under the delusion that multi-tasking is necessary and harmless. It is neither. Secondly, insurance companies are bound to wake up and smell this distinctly acrid brew: underwriters for general liability and fleet auto policies will begin to ask whether potential insureds have policies in place prohibiting the use of cell phones while driving. Those failing to implement such policies may find themselves scrambling for coverage. Perhaps a few innovative carriers will begin to offer discounts to employers with credible policies in place.
Employees subject to cell phone restrictions are beginning to develop new means of coping. Heck, there are support groups for everything, why not for cell phone withdrawal? Here are some of the tips that have emerged:
Plan Ahead. Call and send messages before leaving your desk.
Play relaxing music in traffic jams to reduce the frustration of "not doing anything."
Turn off wireless devices. Still tempted? Lock them in a bag. Place the bag in the trunk.
Put a message on your voicemail saying, "I'm in a meeting or driving."
Take a cab instead of driving, especially on out-of-town trips.
Warn people who regularly call - i.e. spouses - that you aren't available in transit.
The Insider would add one more tip: when driving, just drive, with one relentless point of attention and with one goal in mind: arriving safely at your destination. For most of us, driving is the riskiest part of the work day, yet we treat driving as a relatively mindless means to an end. Alas, if we are not careful, driving may be the last thing we ever do.