Archive for October, 2006

The Pain Conundrum

Monday, October 9th, 2006

Workers comp is about workplace injuries and injuries almost always involve pain. So it’s no surprise to see painkillers at the top of the leader board for medicines prescribed in the comp system. The Hartford has published the latest rankings, which is still dominated by powerful and exotic drugs. Oxycontin is still number one, for reasons that defy logic but give rise to serious partying among the talented sales team at Purdue Pharma. (This particular drug comes with plenty of warnings.) The Cox-2 inhibitors (Vioxx and Bextra) have disappeared (for obvious reasons). Here’s the entire top seven:
1 Oxycontin
2 Gabapentin (generic neurontin, an anti-seizure med useful in reptitive motion pain)
3 Hydrocodone (generic Oxycontin)
4 Lidoderm (for burns)
5 Celebrex (usually for arthritis pain)
6 Actiq (see below)
7 Oxycodone (another generic version of Oxycontin)
Our colleague Joe Paduda blogged this important issue back on September 27. He questions whether doctors are managing pain or just passing out pills. He is particularly interested in a newcomer to the top 7, Actiq, a powerful new pain reliever developed specifically for cancer patients with severe pain that breaks through their regular narcotic therapy. (As I recall, Oxycontin also began as a drug for terminal cancer patients.) Actiq is an opioid narcotic more powerful than morphine. The medicine comes in the form of a flavored sugar lozenge that dissolves in the mouth while held by an attached handle. Gee, it not only kills the pain, it tastes like candy. Yum! This new favorite comes with a hefty price tag ($1,200 a month), but that’s hardly a problem in the comp system, as injured workers are not troubled with a co-pay.
The FDA has some warnings that accompany this latest designer drug. Actiq may be fatal to children. Because Actiq is designed to be dissolved slowly in the mouth, it’s not hard to imagine kids trying it out. FDA approved Actiq under special regulations that restrict distribution as defined in a comprehensive risk management plan. Pardon my cynicism, but I wonder just how many injured workers are provided with detailed risk management plans when they receive a script for this drug.
Living with Pain
It’s beyond the scope of this blog to tackle the issue of pain medications and why doctors prescribe one drug over another. But the big picture is pretty clear. Doctors treating workplace injuries routinely write scripts for the most powerful drugs available. They appear to move rather quickly toward drugs that were originally designed for the chronic, intense and long-term pain of a terminal illness. Most workplace injuries resolve themselves relatively quickly, so while the initial pain may well be acute, it usually does not – and should not – become chronic. When pain does become chronic in the workers comp system, it is almost always an indication that the employee has not returned to work.
All of this leads us to speculate on the relationship of pain to time: if all the key players (employer, doctor, insurer) focus relentlessly on returning injured employees to work, if we give these employees the opportunity to work through the pain while continuing to function in the workplace, we would probably see a greater reliance on pain drugs at the lower end of the spectrum. In other words, a comp system functioning at optimal levels would have a radically different list of top seven drugs. Needless to say, despite a leveling off of pharma costs, the workers comp system from state to state is not functioning anywhere near these optimal levels.

News Roundup: Health Wonkery, DBA, NLRB ruling, and more

Thursday, October 5th, 2006

Health Wonk Review – Joe Paduda hosts Health Wonk Review – the Harvest Moon Edition – a meaty issue with lots ‘o links to substantive posts. With 57 percent of the claims dollar going to medical costs, we are inextricably linked to the larger health-care market. HWR is a good way to keep an eye on the trends.
Additions to the blogroll We’re adding a few links to our blogroll in the sidebar: Labor and Employment Law Blog by George Kittredge and The HR Lawyer’s Blog by Texas labor and employment attorney Christopher J. McKinney – both are worth checking out.
Absolute Shocker of the Week – Worksafe Victoria’s construction safety program publishes weekly photos of dangerous construction work sent in by inspectors and subscribers so that they can be used for safety training or tool-box meetings. hosts and archives these Weekly Shockers and Bodgey Scaffolding photos.
Defense Base Act (DBQ) – The Defense Base Act extends workers’ compensation benefits to employees working for private employers affiliated with the military or certain government-related business outside the continental. Learn more about coverage and 10 Things You Should Know About the DBA. Actually, the article lists 17 things you should know. Regardless of the number, it’s a good overview.
Topical funThe Drugs I Need – an amusing animated music video clip about prescription drugs by the Austin Lounge Lizards.
NLRB rulings – Jordan Barab provides an in-depth analysis of the National Labor Relations Board’s recent Kentucky River rulings from the labor perspective. The rulings set parameters about who is considered a manager and who is considered an employee. Jordan discusses how this ruling excludes millions of workers – notably nurses – from union membership. He quotes extensively from the dissension offered by two Board members. Wilma Liebman and Dennis Walsh.

“Liebman and Walsh point out that the legislative history of the act distinguished between real supervisors “vested with such genuine management prerogatives as the right to hire or fire, discipline, or make effective recommendations with respect to such action ” and “straw bosses, leadmen, set-up men, and other minor supervisory employees.”

“… Walsh and Liebman note that unlike real supervisors, charge nurses do not have the ability to hire, fire or discipline, nor do they have any formal role in the employee grievance process. In addition, they spend the vast majority of their time in line work “a fact that strongly tends to establish their status as s minor supervisory employees.”

“… Today’s decision threatens to create a new class of workers under Federal labor law: workers who have neither the genuine prerogatives of management, nor the statutory rights of ordinary employees. Into that category may fall most professionals (among many other workers), who by 2012 could number almost 34 million, accounting for 23.3 percent of the work force.”

Sign of the times: medical tourism

Tuesday, October 3rd, 2006

If the term “medical tourism” hasn’t crossed you radar screen yet, it will soon because tens of thousands of your fellow citizens are now traveling to India, Malaysia, Thailand, and Turkey to have surgery performed at bargain basement prices. There are even medical tourism agencies cropping up to help prospective travelers match the right destination with their medical needs and arrange all the travel details.
Why would people stray so far from home risking all the vagaries of a foreign medical and legal system for a medical procedures available within a few mile radius of home? Cost is the obvious reason. A hip replacement that would cost $40,000 here might cost under $6,000 in India. Rotator cuff repair would cost less than a tenth the price, or about $3,700 versus $40,000. Those are numbers that would make you think twice.
Faced with medical costs that have skyrocketed year after year, many employers and insurers are looking at those numbers and finding them attractive, too. To curb costs, Blue Ridge Paper in Canton, N.C., recently made plans to send paper mill technician Carl Garrett to India for gall bladder and shoulder surgery – they even offered Garrett 25 percent of the savings, a deal he found appealing. That is, until United Steelworkers interceded and put a halt to the plans. USW President Leo Gerard had this to say in a letter to Congress.

Our members, along with thousands of unrepresented workers, are now being confronted with proposals to literally export themselves to have certain “expensive” medical procedures provided in India.

With companies now proposing to send their own American employees abroad for less expensive health care services, there can be no doubt that the U.S. health system is in immediate need of massive reform.

The right to safe, secure and dependable health care in one’s own country should not be surrendered for any reason, certainly not to fatten the profit margins of corporate investors.

Right now, much of the surgery involves elective procedures such as dentistry and plastic surgery, but demand is rapidly accelerating. How long before employers and insurers are looking to have injured workers fly to Phuket to get a rotator cuff repaired?

“Crackberry” Addicts: One More Email for the Road…

Monday, October 2nd, 2006

It’s only Monday, so it might be too early in the week for this. But the Insider is committed to keeping our readers informed on the latest developments in risk and human resource management. Today, we confront the physical, emotional and legal time bomb of BlackBerry addiction.
We first tracked the health implications of using tiny keyboards in our “BlackBerry Thumb” posting in February of last year. Well, repetitive motion is certainly a potential problem, but that may prove to be the least of the worries for employers who hand out these devices. We now find that the seductive technology embodied in PDAs is leading workers into hospitals, mental health facilities and courtrooms.”Crackberry” devices are addictive. Workers find themselves unable to put the little contraptions down. By connecting workers 24/7 to their jobs, employers suddenly find themselves on the hook for unanticipated liabilities.
The Independent out of Great Britain tells us of Nada Kakabadse (now that’s a splendid name!), a professor at England’s Northampton Business School. The good professor warns British employers that they could face multi-million-pound legal actions from BlackBerry-addicted staff on a similar scale as class law-suits taken against tobacco companies. That’s a pretty big scale, indeed! Research by the University of Northampton has revealed that one-third of BlackBerry users showed signs of addictive behaviour similar to an alcoholic being unable to pass a pub without a drink. “Just one more email for the road…”
Textbook symptoms
The report found that some BlackBerry users displayed textbook addictive symptoms – denial, withdrawal and antisocial behaviour – and that time with their families was being taken up with BlackBerry-checking, even at the dinner table.
As a result, Professor Kakabadse notes that employers are being sued for failing in their duty of care to staff and in following health and safety guidelines. In one case in the US, a female business consultant claimed that her marriage fell apart because she was constantly checking messages. She ended up losing custody of her children and sued her employer for damages. [Note to our lawyer readers: I have no citations for this and the subsequent cases.]
Written Policies
“Enlightened companies that issue BlackBerrys as standard like pen and paper should also have policies on how to use them, so that people can use technology in a way that doesn’t have an addictive side,” said Professor Kakabadse. So perhaps your written policy should require that the device be turned off during dinner, during any interactions with spouse and children, during love making for sure and at bedtime. [Just how such a policy would be enforced is beyond the scope of this posting.] One Chicago hotel has even offered to lock up your Blackberry, so you can enjoy your stay unencumbered and unconnected.
The Independent article cites another recent case, where a woman sued after putting cleaning fluid on her baby’s nappy instead of baby oil because she was distracted by her BlackBerry. [We sympathize with this poor working mom for making such a common mistake in the nursery. No question, it’s her employer’s fault.]
One study reveals that nine out of every 10 users have a compulsive need to check for messages and that nearly half experience long-term negative consequences associated with carrying a BlackBerry. A survey of business workers by researchers at the Sloan School of Management at Massachusetts Institute of Technology in the US found that employees were constantly tired because they were waking up in the middle of the night to check or send messages. One interviewee likened the sense of potential gain from staying in touch with work to “pulling the lever of a slot machine”.
24/7 = Always at Work
A professor at Rutgers’s School of Business, Gayle Porter, predicts in a soon-to-be-published study that disgruntled workers who feel they are unable to turn off their personal digital assistants and mobile telephones will begin suing their employers for their technology addictions — and that such lawsuits could potentially cost corporate America hundreds of millions of dollars.
“If companies develop a culture in which people are expected to be available 24 hours a day, then they should be prepared for the physical and psychological consequences,” Mrs. Porter said. “Addicts exhibit extreme behavior and have no control over themselves. So a corporation handing someone a BlackBerry on his first day of work could be seen as enabling, even accelerating, a serious addiction to technology.”
Be Forewarned
The trends are clear, the dangers incontrovertible. Uncontrolled use of Blackberry-type devices can lead to physical, mental and social debilitation. Someone is bound to announce the development of a new 12 step program for Crackberry addicts. The road to recovery will begin with the assertion that “I am an addict.” Meanwhile, employers should develop comprehensive written warnings to accompany the provision of any PDAs. These guidelines should set clear parameters for appropriate Blackberry use. With half the marriages in this country already ending in divorce, employers need to avoid any possible inference that work – and work-provided equipment – is a significant cause of marital discord. In the ever-expanding definition of risk management, this is one area where increased vigilance – and a few disclaimers – are definitely in order.