Archive for June, 2005

Heat stress: fluid and electrolite imbalance can be fatal

Thursday, June 30th, 2005

Heat kills. This is a fact that was underscored publicly last week with the release of autopsy results for Scott Laio, a 20-year-old Boston College student who collapsed and died after rowing in the Dad Vail Regatta in May. The Philadelphia Medical Examiner’s Office attributed the cause of death to a fluid and electrolyte imbalance and heat stress. Physical exertion causes the body to lose fluid through sweat, and it’s essential that fluid be replaced at regular intervals. The U.S. Army – an entity that has some amassed some deep knowledge in the business of physical exertion in conditions of extreme heat – recommends minimum and maximum fluid replacement guidelines(PDF) for varying levels of exertion, as well as other heat injury prevention resources.
Heightened risk for some workers
Here in New England, we’ve been in the throes of an oppressive heat wave for the last week that has left me sluggish, and wistfully hoping for a late-afternoon thundershower at the close of each day. But as I slip from air-conditioned office to air-conditioned car, I think of the workers who have little relief from the heat. Outdoor workers such as agricultural workers, landscapers, lifeguards, construction crews, and road workers are particularly at risk for heat-related illnesses. And pity the outdoor workers whose jobs call for protective equipment, like firefighters and pesticide workers – the risks are that much greater because heavy gear can interfere with sweating, which is the body’s natural cooling mechanism.
ErgoWeb has a report on new heat stress resources for firefighters and other workers who work in environments that put them at heightened risk for heat disorders. The article reports on research conducted by Tom McLellan and Glen Selkirk:
“Working with Toronto Firefighters in ambient summer conditions, the researchers compared active and passive cooling strategies in combination with different levels of hydration. They found that the active approach — a combination of fluid replacement and misters or the submersion of the forearm and hand in cool water — effectively brings down the body’s core temperature. The study found that this combination was twice as effective as the passive approach — hydration and the removal of the protective clothing only.
This research offers corroboration to a practice that many of us may have intuitively known in our day-today lives, but that may nor be widely employed in work settings.
Preventing heat-related illnesses
Of course, workers don’t need to work outdoors, in heavy clothing, or in extreme conditions to be at risk. A sudden or prolonged heat wave can put many other workers at risk. And a variety of individual factors such as age, weight, physical conditioning, medication, alcohol, caffeine, and salt can heighten the risk.
Employers would do well to review OSHA’s Heat Stress Guide and conduct self-assessments about their own seasonal readiness for worker heat stress prevention. The article Beating the Heat by Donna Miles in Occupational Hazards offers some good advice. Here are some tips from the article:

  • Encourage workers to drink plenty of water – about a cup of water every 15 to 20 minutes, even if they are not thirsty – and avoid alcohol, coffee, tea and caffeinated soft drinks that dehydrate the body.
  • Help workers adjust to the heat by assigning a lighter workload and longer rest periods for the first five to seven days of intense heat. This process needs to start all over again when a worker returns from vacation or absence from the job.
  • Encourage workers to wear lightweight, light-colored, loose-fitting clothing. Workers should change their clothes if they get completely saturated.
  • Use general ventilation and spot cooling at points of high heat production. Good airflow increases evaporation and cooling of the skin.
  • Train first-aid workers to recognize and treat the signs of heat stress and be sure all workers know who has been trained to detect early signs of heat-related illness. Permit workers to interrupt their work if they become extremely uncomfortable.
  • Consider a worker’s physical condition when determining fitness to work in hot environments. Obesity, lack of conditioning, pregnancy and inadequate rest can increase susceptibility to heat stress.
  • Alternate work and rest periods, with rest periods in a cooler area. Shorter, more frequent work-rest cycles are best. Schedule heavy work for cooler times of the day and use appropriate protective clothing.
  • Monitor temperatures, humidity and workers’ responses to heat at least hourly.

When the Independent Contractor Strategy Literally Blows Up

Tuesday, June 28th, 2005

The Insider has frequently explored the ramifications of getting work done through employees (who are protected by workers comp) and through independent contractors (who have no such protection). The practice of using independent contractors can save a lot of money in workers comp premiums, especially when your employees perform the more expensive classes of work such as in those in the building trades. But sometimes the strategy backfires.
Fifteen people were killed in a March 23 blast at a BP oil refinery in Texas. More than 170 were injured, dozens of them seriously, in what was the worst United States refinery accident in recent memory. Anne Belli of the Houston Chronicle has done a terrific job of reporting on this tragedy. Although performing regular work at the site, most of the injured were not BP employees; they were independent contractors. While the strategy of staffing the plant with contractors surely made business sense at the time, in retrospect, from a financial perspective, it has turned into a real disaster.
Exclusive Remedy
Had the killed and injured workers been employees of BP, workers comp would be the exclusive remedy. Dependents of the deceased workers would be entitled to death and dependency benefits; the injured workers would collect indemnity benefits and all their medical bills would be paid. Even though there are some indications that the company failed to follow through on safety issues, even though the company may have been in some respects negligent in their operation of the facility, employees would be limited to the statutory benefits under workers comp. Employees cannot sue their employers for work related injuries. Under the usual workers comp benefit structure, the fatalities would generate claims valued at less than $1 million; for the seriously burned, who face years and years of treatments, you might see reserves in the $3 to 5 million range. It’s hard to believe, but these amounts are far less than what BP is now facing.
Contractors can Sue
Because many of the deceased and injured were not BP employees, they are suing BP as a third party and collecting not just indemnity and medical benefits, but also tort liabilities for pain and suffering, loss of consortium and so on. The liabilities for BP in this situation are formidable. In what can only be regarded as a remarkably rapid process, BP has already agreed to settle with several of the families of the contractors and is in the process of settling with dozens more. And here’s the financial rub: these settlements are running in the tens of millions for each family. The article quotes a number of the plaintiff attorneys involved, who seem stunned that BP has accepted liability so readily and is offering such generous settlements to resolve the cases.
In the days following the explosion, BP seemed inclined to blame the workers for not following procedures. If they really thought that this was a viable position, they would probably not be so interested in offering generous settlements. The post accident investigation brought in federal investigators with the U.S. Chemical Safety and Hazard Investigation Board. The investigators have stated that BP management may well have dropped the safety ball. Had BP equipped the blowdown system with a flare, as is standard in the industry, the hydrocarbons might have been burned safely away and the accident might have been prevented. In addition, OSHA warned BP 13 years ago that the lack of flares on a vent stack at the refinery was hazardous to the environment and to workers. I think BP’s lawyers took a careful look at the history and threw in the proverbial towel.
Bottom Lines and Human Lives
This is nothing less than a tragic tale of unnecessary death, suffering and loss. I suppose it’s better for the families that their loved ones were not BP employees — the proposed settlements will support the survivors far better than comp benefits would have. But the real question is not really one of business strategies and honing the bottom line. It’s how BP lost sight of the real dangers in their workplace and missed numerous opportunities to fix them. How ironic is it that the most cost effective strategy for BP had nothing at all to do with employees versus contractors? No, it was simply a matter of listening to OSHA back in 1992 and making some adjustments in the plant infrastructure. A safer workplace would have been a lot less expensive to operate than what BP has now — a fire ravaged plant and a tragically decimated crew .

Texas enacts safe lifting guidelines for a hazardous industry

Tuesday, June 28th, 2005

Quick – name the three leading industries with the overall greatest numbers of injuries and illnesses.
I’ve run this little pop quiz on people who work in the industry and those who don’t, and it’s rare that people get the right answers. According to Bureau of Labor Statistics, the dubious *winners* in the win, place, and show categories are laborers and material movers; heavy and tractor-trailer truck drivers; and nursing aides, orderlies, and attendants. (source)
For many people, this information is something like a game my nieces used to play called “one of these things is not like the other.” Many are startled to learn that our nation’s healthcare workers are right up there in the ranks of the nation’s most hazardous professions. The reason is largely due to patient handling that takes a heavy toll in back and neck injuries. An article in ErgoWeb describes some of the hazards for nursing home staff.
“In “Ergonomics: Guidelines for Nursing Homes,” OSHA identifies work-related musculoskeletal disorders (MSDs) that include low back pain, sciatica, rotator cuff injuries, epicondylitis and carpal tunnel syndrome. It isn’t difficult to pinpoint why MSDs are such a problem. Nursing home employees care for residents who are disabled by frailty, stroke, fractures, Alzheimer’s disease and other conditions. The work involves heavy lifting, often in confined and awkward spaces.
Some good news from Texas
From Jordan Barab’s Confined Space, we learn that Texas has taken legislative steps to protect healthcare worker safety. The state is the first to enact legislation (TX SB 1525) requiring hospitals and nursing homes to implement a safe patient handling and movement program. The legislation takes effect on January 1, 2006. In his post, Jordan notes:
Most significantly, the law requires the plan to include “procedures for nurses to refuse to perform or be involved in patient handling or movement that the nurse believes in good faith will expose a patient or a nurse to an unacceptable risk of injury.”
This is good news for healthcare workers and hopefully other states will follow suit since OSHA has issued only ergonomic guidelines which, although good for what they are, many feel are meaningless in terms of affording workers any protection.

Morbid Obesity: One Man’s Tale

Monday, June 27th, 2005

David Montgomery, a staff writer for the Washington Post, has written a moving and intimate article (registration required) about John Keitz, who weighs 625 pounds (down from his maximum weight of 781 pounds). The article is accompanied by a remarkable set of photographs, which you should be able to link to at the article. Keitz is so heavy his legs will not support his weight. The last time he stood on his feet was Aug. 1, 1998. That night he was making macaroni and cheese for his wife, Gina. He boiled and drained the noodles. Right after he cut in the Velveeta (nutritionists take note), he went down — and he has been bedridden ever since. Keitz is 39 years old. This article presents Keitz as a man of Falstaffian dimensions, who regales the reporter with his exploits as a youth and dreams of the day when he can sit up and even stand up on his own.
Morbid Obesity Personified
Keitz has to lie on his front, because if he were to lie on his back, rolls of flesh would press on his windpipe and suffocate him. His head never touches sheet or pillow. At night, his left cheek nestles upon a soft white pile of shoulder and breast meat.
Every time Keitz must be moved — usually to the hospital to treat his asthma — a major public drama ensues. One time, firefighters removed two windows from his second-story apartment and extracted him with a lift truck. More recently, firefighters used a whale sling from the National Aquarium in Baltimore to haul him out of his house in Dundalk. They put him on a flatbed truck. His ordeal was rehashed on late-night television and morning radio.
Obesity as Illness
At 26, Keitz got the first dramatic warning that his weight was barreling out of control. On the job at a bowling alley, his knees gave out. Doctors diagnosed severe arthritis. He stopped working regularly and began receiving disability checks. I think we can assume that the disability payments were under SSDI and not workers comp.
Montgomery writes that many scientists, doctors and health insurance executives are coming around to the conviction that obesity is a disease. But it is a disease with personal responsibility attached. Advocates for obese people say health care is full of conditions that involve personal choice: smoking; alcoholism; gum disease brought on by poor dental hygiene; skin cancer following too much tanning. Yet obesity is unique in how much blame is placed on the victims themselves. “Once you take off this moral interpretation, it is a dysfunction of the body and an abnormal physiological state,” says Morgan Downey, executive director of the American Obesity Association in Washington.
Workers Comp Risks
I would direct you to the 6th image in the gallery of photos that accompanies the article. (It is sometimes difficult to access Washington Post articles, so I will describe the scene in detail.) Six men from East Coast Ambulance surround Keitz. They have placed a yellow rubber tarp under him. On the count of three, they all lift. You can see the strain on the face of one of the men near to the camera — the faces of the others are obscured in the dim light of the dingy apartment. The men have only the yellow tarp to hold — there are no handles, so the lift places tremendous pressure on their forearms, fingers and wrists. Four of the men are clustered around Keitz’s formidable upper body, so only two are available to lift his lower body. Theoretically, it’s a 105 pound lift for each man. However, Keitz’s great bulk is prone to shifting, so the weight itself may change as they head for the ambulance. Indeed, you can tell from the photo that some of the men bear more weight than others (at least one appears to be “dogging” it). Ergonomically, the lift is far from ideal. Beyond that, there is clutter on the floor — tripping hazards for the men as they begin to move Keitz toward the door. There is no stretcher or gurney in the photo — it appears that they are going to carry him out of the house to the waiting ambulance.
The doorway is of average width. How will the men get through it, when Keitz’s bulk alone will barely fit through? The men at his head will have to squeeze ahead, while trying to keep Keitz from slipping out of the sling. We are left with no answers, as this is the only photo of this particular move. Given the absence of additional details in what is a very comprehensive article, perhaps we can assume that the lift was performed without any problems. No workers comp claims this time. (One hospital client of ours had two serious back injuries in the single lift from an ambulance of a similarly sized person.)
Heavy Issues
Obesity is surely a personal crisis for those who suffer from it, as well as for those who love them. It presents challenges to employers. It is also a crisis for the insurance industry — to pay or not to pay for stomach stapling, that is the question — see this Los Angeles Times article. On the front lines, it’s a huge challenge for health care workers who are called upon to move morbidly obese individuals under very difficult conditions. In the working world, it’s not always possible to perform the work as outlined in the ergonomic textbooks. All too often the workers — and their employers — are left to bear the consequences.

New weblogs added to the resource sidebar

Thursday, June 23rd, 2005

When we first started Workers Comp Insider, related weblogs were far and few between. We are pleased to see new entrants are joining the so-called blogisphere almost daily now – be sure to visit our expanding blogroll to check out blogs that we find of interest. Here are a few that we’ve added today:
We’re pleased to see that our friends at the very useful have added a weblog to the many services they offer – visit them at Comp Blog. Today, they feature a radio interview with an attorney on the workers comp changes in Oklahoma. We wish them the best – they have been kind enough to feature our posts in their new daily blog center.
Specialty Insurance Blog by Bob Sargent, President of Tennant Risk Services, is aimed at insurance wonks, particularly those with an interest in specialty lines. Lately he’s made a few posts on contingent commissions and the need for transparency, a topic that commands attention for many of us.
MSSP Nexus is a lively blog by Rita Schwab with news and commentary aimed at medical professionals and those who work in healthcare management, medical staff administration, quality, accreditation, law, and provider credentialing. We found the link at Joe Paduda’s blogroll a few weeks back, and have been keeping an eye on it since. Read her recent post on a federal court decision that held that a Louisiana hospital had a duty to disclose information about their medical staff members to a Washington hospital to protect future patients.
The Disabled Worker Law Blog is a substantive blog by the staff at Turley, Redmond & Rosasco. We have several employer-leaning law blogs in our sidebar, so we thought that this would be a good addition to offer another perspective. Of particular interest is this post on how the proposal to raise the age for Social Security benefits to 69 is likely to put more workers on disability. We recently posted about older workers – such a change could add a further wrinkle to what is an emerging risk.
Business guru and author Tom Peters has an interesting weblog as the main page of his website. Tom and his colleagues at the Tom Peters Company all contribute posts and can be counted on for interesting and informed business commentary. I like the fact that “work that makes a difference” is among his own company’s values. Call me a little bit corny, but I like to think of that as a mission for all of us employed in workers compensation: making a difference for employers and employees alike. Social insurance is not really about pushing around pieces of paper – it’s about people.
And lastly, here are a few new tools we’ve found useful:
Abbreviations and Acronyms of the U.S. Government – a handy little reference guide. – lots of good tools and resources here on many aspects of human resources. Some require paid registration, but many are free.
National Guideline Clearinghouse – a public resource for evidence-based clinical practice guidelines. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. NGC was originally created by AHRQ in partnership with the American Medical Association and the American Association of Health Plans (now America’s Health Insurance Plans [AHIP]).

Drug Advertising: Only in America

Wednesday, June 22nd, 2005

The Insider has occasionally wondered about the thought process that leads a doctor to prescribe a specific medication for a particular injury. We are intrigued by the continued popularity of Oxycontin, which, even with its track record of abuse and addiction, is still the one of the most popular pain killing drugs in the workers compensation system. We wonder how drug companies influence the decision-making of doctors. How do they get inside the doc’s head?
Today we explore an easier question to answer: How do drug companies get into the heads of consumers? An article in today’s Los Angeles Times (registration required) explores the impact of direct advertising on consumers and discusses a growing backlash against these drug ads.
New Speech
Drug advertising to the general public is a $4.5 billion dollar industry — and a fairly new one at that. The FDA has permitted these direct appeals only since 1977. It is interesting to note that the U.S. is the only country that permits pharmacy companies to bypass doctors and go directly to consumers in their search for increased market shares. So every day we are bombarded with images in the media: wonder drugs that will lower cholesterol, control diabetes, improve sex lives, grow hair, cure flatulance, conquer depression and presumably, enable us to live forever.
For whatever reason, drug ads appear to work. A Kaiser Foundation survey in 2001 found that 30% of Americans had spoken to a physician about a specific medication they had seen advertised. Of these, 44% reported that they came away from the doctor with the prescription they asked about. These numbers have probably gone up since the survey was completed. This might be good — assuming that the ads increased consumer awareness of real medical problems. Or it might be bad — assuming that harried doctors wrote the scripts to satisfy their customers.
Doctors and public health officials are increasingly wary of the impact of advertising on American medicine. They fear that the advertising leads to the widespread use of costly brand-name medications, in many cases by people who don’t really need them, or who should not take them, or people who might achieve the same result with more established and less expensive treatment.
The Vioxx Story
Vioxx, developed as an arthritis drug, was touted through a $300 million ad campaign between 2000 and 2001. It is probably not a coincidence that in 2002 it was the third most prescribed drug in the workers compensation system — prescribed, I would note, not for its original use in arthritis (which is not work related), but for pain. In September 2004 Vioxx was removed from the market due to “increased risk of cardiovascular events” — industry speak for “heart attack.”
After eight years of increasingly aggressive advertising, even the pharmacy industry is having second thoughts. Or it might be more accurate to say, the industry, anticipating a backlash from doctors and regulators, is taking steps to voluntarily limit advertising. There is no way they will agree to a total ban — once the door was opened to advertising, it will prove impossible to shut it completely. If you are interested in the industry’s own perspective, one of their lobbyists resides here. It’s a matter of “free speech” — although I often wonder why “free speech” costs billions of dollars…
AMA Study
The American Medical Association, perhaps recognizing the political realities, has stopped short of requesting an outright ban on drug advertising, although many of their members would probably like to see one. (You can be sure that most doctors do not appreciate their patients showing up with a diagnosis and drug solution in hand!) The AMA has set up a study committee to explore the impact of advertising on treatment. It will be interesting to see just how radical a position the AMA eventually stakes out.
In the meantime, I look forward to tracking the industry’s self-imposed reforms. I will certainly keep my eye out for more balanced ads, carefully scripted scenarios which emphasize education about symptoms and which balance the positive effects of the drug with cautions about any potential side effects. I do have a vague suspicion that the new ads will be indistinguishable from the old: curing every possible ailment, real and imagined, making the user indescribably happy and promising the good life forever.

The Aging Workforce – Iceberg, Dead Ahead

Tuesday, June 21st, 2005

The aging of the American workforce is a dynamic that we have been tracking closely. I can personally swear that as one ages the body begins to wear down. Oh, that this truth were not so.
In my father’s day, it was common for people (mostly men) to work until age 65 and then retire on the proverbial company pension augmented by social security benefits. That changed dramatically toward the end of the twentieth century.
In the mid to late 90s, the goal became to retire early; age 55 would be nice. The dot-com bubble suckered us all into thinking it could be done. In 1998, a Gallup survey, conducted for USB Financial Services, found that only 36% of respondents planned to wait to retire until age 62 (pdf). But the horror of 9/11, the war on terror, the stock market collapse of 2001 that substantially reduced portfolios and the myriad Enron-type scandals that blew away entire pension funds all hit older workers smack dab in the middle of their futures. And when Gallup conducted the same survey in 2002, the percentage of workers who planned to put off retirement until after age 62 had grown to 47%. In 2004, the number had ballooned to 57%.
So, now we’ve returned to my father’s time, except without the pensions and with significantly delayed and threatened social security. Older workers will continue to get older on the shop floor.
Do you think that the workers’ compensation system is prepared for this? Age isn’t considered in workers’ comp manual rating. (Neither is education, but we’ll leave that for another time.)
Rotator cuff sprains and aging
Here’s something to think about. The rotator cuff sprain (something I know a great deal about) ranks 28th in terms of injury frequency for all workers, but 3rd for workers age 65 and above. In fact, 3 of the top 4 injuries to older workers are of the soft tissue variety to the shoulder, neck and lower back. To see a dramatic example of how bodies really do break down over time consider the following NCCI chart, which depicts the frequency of rotator cuff sprains by different age groups.

When valued at 18 months, the rotator cuff sprain of an older worker costs about a third more than for any other age group, $28,360 versus $21,910 for all other age groups. Moreover, every one of the top ten injuries to older workers costs substantially more than the same injuries among younger workers. And this situation will get worse as more and more older workers are literally forced by financial circumstances to stay on the job.
We believe that this phenomenon is so serious an issue that it may ultimately impact the way manual rates are calculated.
The impact on employers
As if running an American company weren’t hard enough already, what does this mean for employers?
It’s a problem. On the one hand, older workers have been doing their jobs for a long time; they’re good at them, and they have experience that just can’t be found in their younger colleagues. On the other hand, although younger workers have more injuries, those injuries are substantially less costly than their older mentors.
A knee-jerk, and very discriminatory, response might be for employers to try to “weed out” the older population and replace it with its younger version. We can only hope no employer starts the long walk down this painful and litigious road.
We’ll continue to think about this issue and report on it in subsequent blog postings. As always, we invite your comments. But for now, we advise employers with aging blue collar workforces to re-double their safety and ergonomic efforts in order to provide as much protection as possible for these very skilled and experienced, but potentially brittle workers.

Google New Hires!

Monday, June 20th, 2005

If you were to Google the name “Dr. Jayant Patel,” you would find over 20,000 references going back a number of years. The more recent entries are undoubtedly the most alarming. “Dr. Death” has been implicated in the demise of 87 patients at a municipal hospital in Bundaberg, Australia. He has become infamous for not washing his hands between surgeries, for failing to use anesthesia during surgery and perhaps most famously, for performing a colostomy backwards (I’m not sure what that would look like, and I don’t really want to know). If you do take a few moments to google his name, you would be more diligent in researching the doctor than were his previous employer and the executive recruitment firm that brought him to Australia. Therein lies our tale.
Bundaberg is a farming community on the eastern coast of Australia, just south of the Great Barrier Reef. They are famous for “Bundy Rum” — an alcoholic beverage that presumably bears no relationship to the star of the dubious sitcom, “Married with Children.” The local municipal hospital was delighted to find a former professor of surgery at the State University of New York who was willing to relocate to Australia. Unfortunately, his tenure down under was not unlike his work in Oregon and New York. He had been suspended in New York and his license had been revoked in Oregon, where he had once worked for Kaiser Permanente.
Whistleblower Blown Off
One of the striking aspects of the story as presented in the New York Times (registration required) involves the head nurse at the hospital, Toni Ellen Hoffman. She continuously raised her concerns about Dr. Patel’s performance with hospital administrators, only to be told that she had a “personality problem.” After a particularly shocking incident, where a 9 year old girl watched her father die through Patel’s neglect, the nurse requested an inquiry. The administration’s response? They named Patel as the employee of the month!
Finally, as the result of a legislative inquiry, Dr. Patel’s name was published in a paper. An enterprising reporter Googled the name and the scandal finally exploded. Dr. Patel fled the country, returning to Oregon where he lives in a mansion and appears to be unenthusiastic about returning to Australia, where he could face charges of homicide.
Management Lessons
We often talk about the potential negligence involved in hiring and entrusting incompetent or dangerous people to carry out their responsibilities. Here we certainly have a case of negligence in hiring: the hospital in Bundaberg was so excited to find a credentialed foreigner willing to join their staff, they did not look beyond the documents he presented about himself. As we have seen, a simple Google search would have exposed Patel as both incompetent and dangerous.
In addition, Patel carried letters of reference from several of his Oregon colleagues. These letters were provided after his termination for cause; the doctors who wrote them are likely to find themselves involved in the many lawsuits that are going to come out of this situation, under the legal concept of “negligent reference.” Then again, perhaps the colleague who described Patel as “above average” has a very low opinion of the average doctor!
Beyond these examples of negligence, hospital administrators really messed up when they failed to respond to the alarms raised by a trusted member of the staff. The administration went into a denial mode that will severely compound their negligence in hiring: it’s bad enough to drop the ball on reference checking, but far more serious to ignore the evidence right in front of your eyes. The lawyers will have a field day.
Some are calling Patel a psychopath. Others think he is simply incompetent. The bottom line is that he did not belong in any operating room, anywhere in the world, including one in a relatively remote town on the shores of Australia. With the advent of the internet, the HR folks in Australia had access to the same data available in New York City. So here’s our advice: google new hires. It doesn’t cost anything, it only takes a few moments, and it might save you a whole lot of pain, suffering and trouble.

Mental Illness Revisited

Friday, June 17th, 2005

We recently blogged a study in mental health that concluded that nearly half of all Americans will suffer from some form of mental illness during their lifetimes. Whenever this type of information is disseminated, it gives rise to inevitable skepticism. When the percentages are high (“nearly half of all Americans”), the numbers may lack credibility.
It turns out that the definition of mental illness is a subject of debate within the psychiatric profession itself. An article in the New York Times (registration required) by Benedict Carey discusses the fault lines within the psychiatric profession. Carey notes that “the boundary between mental illness and normal mental struggle has become a battle line dividing the profession into two viscerally opposed camps.”
On one side are the doctors who say that mental illness should be defined in broad enough terms to include relatively mild conditions, which they believe often lead to more severe problems later. On the other side are the doctors who want current definitions to be tightened, to ensure that resources are focused on the people who need them most. These latter doctors are concerned that when the definitions are too broad (as is perhaps the case in the recent study), the general public (and perhaps the occasional blogger) has a tendency to scoff at the findings.
Defining Mental Illness
There is a lot at stake here and as always, insurers are caught in the middle. The battle ground may well be the pending revision of the American Psychiatric Association (APA)’s diagnostic manual — the catalog of mental disorders on which treatment and the profession itself are based. The next edition is due out in 2010 — and right up until the printing deadline there will be debate about where to establish the cut-off points for clinical disease.
Diagnosing mental illness can be similar to working on certain types of lower back pain. In the absence of any objective findings, the doctor is limited to observations of behavior and the patients’ own answers to basic questions: how do you feel? How bad is it? What effect is it having on your life?
Ultimately, this comes down to the issue of severity: what effect does the condition have on an individual’s ability to function at home, in public and in the workplace? Magellan Health Services, a major provider of mental health insurance, has developed standardized tests to determine the degree of impact on someone’s life. They also have a report on “common warning signs,” which I would very much like to read. Unfortunately (and I caution you not read too much into this), the PDFs for this report appear to be inaccessible, at least at this time.
Mental Illness and the Workplace
Just as physical health impacts one’s ability to perform certain jobs safely, relative mental health can impact safety as well. This is an area where most employers rightfully fear to tread. On the one hand, the workplace may be a danger zone for people who are experiencing mental disorders. On the other hand, the workplace is part of the safety net for all of us — we often rely on the consistency and certainty of work to define ourselves and to stabilize our identities.
So when confronted with bizarre or unusual behavior, what should employers do? The Canadian Psychiatric Association has put together a useful brochure on “mental illness and work.” This document includes some basic guidance for employers in handling employees who may be suffering from mental illness. They recommend approaching employees with flexibility and compassion. As with any situation requiring accommodations, the answers often emerge from candid and confidential conversations with the workers themselves.
The Times article quotes a 48 year old business analyst who developed panic attacks to the point where he dreaded even small meetings with friendly coworkers. “It’s very bizarre; the only way I can describe the feeling is, Imagine walking down the street at dusk having someone put a gun in your face and threaten to kill you – having that absolute terror before a routine work meeting.”
It’s not hard to imagine that such a phobia would directly impact this person’s performance at work. Indeed, a typical employer would be likely to document the performance issues and eventually terminate him. Fortunately, this man’s wife had watched a therapist talk about social phobia on television, which led directly to his getting help. This is a case of a mental illness that gradually approaches and then passes the threshold where it impacts the individual’s ability to function.
It will be interesting to track the APA’s progress in revising the diagnostic manual. The final wording will directly impact how we perceive certain behaviors — and what behaviors will be considered “compensable” by insurers. Polls, studies and definitions aside, we may never be able to determine what percentage of Americans suffer from mental illness. But one thing is certain: the drama of untreated mental illness will play itself out in the narrow confines of families, in public spaces, and in workplaces across America.

Ohio BWC scandal widens

Thursday, June 16th, 2005

Folks at the Ohio Bureau of Workers Comp (BWC) desperately need to remember the first rule of holes: when you are in one, stop digging. Today, reports are that the BWC is considering $80 million in givebacks to employers in the form of an 8 percent dividend in a misguided attempt to demonstrate solvency. Last month, the BWC voted to raise rates by an average 4.4 percent beginning July 1. This “pay no attention to the man behind the curtain” scheme would be a knee-jerk response to the ever-widening scandal that now encompasses the loss of hundreds of millions of dollars in state funds. Nearly every day finds a new shoe being dropped. Some of the revelations are boggling:

There are many other bizarre twists and turns that span several states, such as stolen wine, guns, and jewelry in Colorado and vacation homes in Florida.
We hope the BWC will drop the idea of employer givebacks until totally independent parties have assessed the full scope of the mess. Sadly, Ohio BWC has already broken faith with taxpayers, with employers that pay premium into the fund, and with injured workers for whom the monies are held in trust. Now it’s time to stop digging.