Archive for April, 2007

News roundup: workplace cancers, medical costs, SC reform, ergonomics, photo of the week

Monday, April 30th, 2007

Workplace cancer – According to the World Health Organization, at least 200,000 workers die each year from cancers related to work exposures, such as asbestos, benzene, and second-hand smoke. Nearly half of those deaths – or 90,000 each year, are related to asbestos. Think that asbestos exposure is no longer a problem here in the U.S.? Think again.
Chlorine exposure – The Arkansas Court of Appeals reversed a denial of benefits for a city water department worker who had died after exposure to chlorine gas. Jerry Slaughter died one month after being spewed in the face by chlorine that escaped from a cracked cylinder. A doctor retained by the city suggested that his death was related to a parasitical infection commonly associated with HIV, so the state Workers’ Compensation Commission found that chemical exposure was “but one factor” contributing to Slaughter’s death, not the major cause. The Appeals Court found Slaughter’s treating physician to be compelling and sided with his opinion that the exposure was “the major precipitation event.”
Implants and pharma costs – Joe Paduda has a few interesting posts related to cost items that can add to a claim’s medical bill. First, he looks at the often all-too-cozy relationship between physicians and big pharma. In another post, he suggest taking another look at the invoice for implants used in spine surgery, bone and joint surgery. The price tag can be hefty – adding 11-33% to hospital bills in California.
South Carolina – does it seem like workers comp reform in South Carolina has been in the offing for an awfully long time? In the light of a recent NCCI recommendation that the loss cost level be increased by 23.7 percent, the Property Casualty Insurers Association of America is speaking out.
Shavers cramp – as the nature of the work we do changes, so do the risks. Jobs have changed considerably since 1923. Check out some of the occupational ergonomic maladies of yesteryear. (Thanks to Ergonomics in the News for the pointer.)
Photo of the week – from the Naval Safety Center – Eyewash Yikes and Eyewash Yuk.

Workers Memorial Day 2007: mourn for the dead, but fight for the living

Friday, April 27th, 2007

Workers’ Memorial Day – April 28 – is both a day of remembrance for workers who have died on the job and a grim reminder that we must all work to prevent further workplace deaths and injuries. April 28 has been dedicated as a day of remembrance since 1989. The significance of April 28th is to commemorate the 1971 date that OSHA was established as an agency to administer the Occupational Safety and Health Act, which became law in 1970. Workers Memorial Day has grown to become an international remembrance – safety advocates, workers, and trade unions in more than 100 counties now observe the event. The AFL-CIO Worker Memorial Day site offers more in the way of information, links, and toolkits, including a state-by-state directory of Workers’ Memorials that have been erected to commemorate workers who have been injured or killed on the job. For a more global perspective, Hazards magazine has a page dedicated to International Workers Memorial Day, which includes extensive links and resources.
Death on the Job – The Toll of Neglect
In conjunction with Workers Memorial Day, the AFL-CIO recently released its annual report, Death on the Job: The Toll of Neglect. Among other things, the report offers a state-by-state snapshot summarizing fatalities, injuries and illnesses, penalties, and the number of OSHA inspectors. It also offers a state-by-state breakdown of fatalities by event or exposure.
The report relies heavily on BLS data for 2005. (We discussed BLS data last August in our post BLS Stats on Dying at Work: Spin Control in the Graveyard.) Here is an excerpt from the report’s summary of key data:

According to the BLS, there were 5,734 workplace deaths due to traumatic injuries in 2005, a decrease from the number of deaths in 2004, when 5,764 workplace deaths were reported. The rate of fatal injuries was 4.0 per 100,000 workers in 2005 compared to 4.1 per 100,000 workers in 2004, a 2 percent decrease. Wyoming led the country with the highest fatality rate (16.8 per 100,000), followed by Montana (10.3), Mississippi (8.9), Alaska (8.2), South Dakota (7.5) and South Carolina (6.7). The lowest state fatality rate (1.1 per 100,000) was reported in Rhode Island, followed by Vermont (2.0),
Maine (2.2), Hawaii (2.3), Massachusetts (2.3) and Michigan (2.3). Twenty-four states saw an increase in either the rate or number of fatalities between 2004 and 2005, with Mississippi, Montana, and South Dakota having the biggest increases in fatality rates.

The construction sector had the largest number of fatal work injuries (1,192) in 2005, followed by transportation and warehousing (885) and agriculture, forestry, fishing and hunting (715). Industry sectors with the highest fatality rates were agriculture, forestry, fishing and hunting (32.5 per 100,000), mining (25.6 per 100,000) and transportation and warehousing (17.7 per 100,000).
Transportation incidents, in particular highway crashes, continue to be the leading cause of workplace deaths, responsible for 2,493 or 43 percent of all fatalities in 2005.

The report goes on to note that BLS data only tells part of the story because it only covers certain segments of workers. For example, It does not include self-employed workers, domestic workers, farms with fewer than 11 employees, employers regulated by other federal safety and health laws, or federal, state and local government agencies. A recent study points to the issue of underreporting:

While government statistics show that occupational injury and illness are declining, numerous studies have shown that government counts of occupational injury and illness are underestimated by as much as 69 percent. A recent study published in the April 2006 Journal of Occupational and Environmental Medicine that examined injury and illness reporting in Michigan has made similar findings. The study compared injuries and illnesses reported in five different data bases – the BLS Annual Survey, the OSHA Annual Survey, the Michigan Bureau of Workers’ Compensation, the Michigan Occupational Disease reports and the OSHA Integrated Management Information System. It found that during the years 1999, 2000 and 2001, the BLS Annual Survey, which is based upon employers’ OSHA logs, captured approximately 33 percent of injuries and 31 percent of illnesses reported in the various data bases in the state of Michigan.

One reason why even more progress in reducing work fatalities hasn’t occurred can be found in the dearth of OSHA inspectors. While the United Nations’ International Labour Organization recommends one inspector for every 10,000 workers as a benchmark, the OSHA reality is far different. The report includes a graphic visual depiction of the number of years it would take each state to inspect every workplace once.
We’ve had occasion to visit thousands of employer worksites over our 20+ years, and we have been heartened by the increased emphasis on safety that we’ve seen. Sometimes that dedication is a heartfelt commitment to workers and to excellence; other times, it is a calculated matter of good business economics – strangely enough, doing the right thing is often the cheapest option. One thing we’ve seen all too often: the safest workplaces are often those that have experienced a death-on-the-job – a truly terrible and traumatic way to join the ranks of the safety believers. Of course, we also recognize that the employers we see are a self-selecting group: those that choose to do better. We are mindful that there are negligent employers, both large and small, who accept injuries, illnesses, and even fatalities as a normal cost of doing business.
Related reading:
The Weekly Toll: Death at work
The sad, quiet death of Bud Morris – father, husband, motorcycle afficianado
The Lonely Death of Octavio Godinez
A terrible burden: the death of a coworker

What is OSHA’s Role?

Thursday, April 26th, 2007

New York Times reporter Steven Labaton presents an interesting portrait of OSHA in action. It’s a story about popcorn. Americans eat more than a billion pounds of popcorn a year. According to the industry, that’s nearly 14 gallons of popcorn for every man, woman and child in the country. Unfortunately, quite a few of the people packaging the product are coming down with a rare and potentially fatal illness. Sounds like an opportunity for OSHA, doesn’t it?
Seven years ago, a Missouri doctor discovered a pattern at a microwave popcorn plant in the town of Jasper. After an additive was modified to produce a more buttery taste, nine workers came down with a rare, life-threatening disease that was ravaging their lungs.
Puzzled Missouri health authorities turned to two federal agencies in Washington. They got two very different responses. Scientists at the National Institute for Occupational Safety and Health (NIOSH), which investigates the causes of workplace health problems, moved quickly to examine patients, inspect factories and run tests. Within months, they concluded that the workers became ill after exposure to diacetyl, a food-flavoring agent. (You can find their recommendations for managing the exposure here.)
But the response at OSHA has been, well, a bit laid back. OSHA did not step up plant inspections or mandate safety standards for businesses, even as more workers became ill. OSHA Director Edwin Foulke says “the science is murky” on whether the additive causes bronchiolitis obliterans, the disease that has been called “popcorn worker’s lung.” You can find a few industry officials who agree with Mr. Foulke, but leading scientists and doctors agree with NIOSH scientists that there is compelling evidence linking the additive to the illness. (Hm, did someone mention global warming?)
In keeping with the OSHA philosophy under the Bush administration, Foulke has not issued any regulations about diacetyl – or anything else, for that matter. Instead of regulations, Mr. Foulke favors a “voluntary compliance strategy,” reaching agreements with industry associations and companies to police themselves. Let’s just sit down, munch a few artificially flavored kernels and come up with a (PR) plan.
Blame the Victim
Early in his tenure at OSHA, Mr. Foulke delivered a speech called “Adults Do the Darndest Things,” which attributed many injuries to worker carelessness. Large posters of workers’ making dangerous errors, like erecting a tall ladder close to an overhead wire, were displayed around him.
“Kids don’t always know what their parents do all day at work, but they instinctively understand the importance of them working safely,” he told the audience, which included children who had won a safety-poster contest. “In contrast, adults could stand to learn a thing or two. Looking at the posters, I was reminded of a couple examples of safety and health bloopers that are both humorous and horrible.”
Listening to Mr. Foulke, I am reminded that administrators also can do the darndest things. They are confronted with strong evidence of a problem – workers falling ill to rare and serious illness. Government scientists confirm that the illness is caused by a chemical in the workplace. So what does OSHA do? Not much.
Perhaps Foulke believes that the workers are being careless: after all, they keep on breathing in these darned factories, don’t they?
Onerous Regulations?
Historically, you can certainly make the case that some OSHA regulations have been ponderously worded, onerous, perhaps even downright silly. But even if you believe in small government, you have to understand the role your agency plays in the working world. OSHA is in charge of workplace safety. If there are unsafe working conditions, OSHA is supposed to respond. Regulations are needed: write the regs as succinctly and clearly as possible, but write them!
Mr. Foulke’s boss, Secretary of Labor Elaine Chao, points out that “there are more words in the Federal Register describing OSHA regulations than there are words in the Bible. They’re a lot less inspired to read and a lot harder to understand. This is not fair.”
Ah, but workers in popcorn factories are dying because a chemical has destroyed their lungs. That’s not fair either. Ideology and the wording of regulations aside, it’s OSHA’s job to mitigate the risk. I don’t care how they do it, but they need to get the job done.

Cavalcade of Risk #24

Wednesday, April 25th, 2007

The Silicon Valley Blogger is hosting Cavalcade of Risk #24 at The Digerati Life. One of the things that I enjoy about this blog roundup is that there are not only good work-related topics, but there’s usually some topics that are useful for one’s non-work life too, such as investing advice and discussion about housing markets.
We also encourage you to spend a little time exploring the host blog. The Digerati Life is the blog of a Silicon Valley-based software engineer who worked at some of the big, familiar names in the tech world during the boom – so she knows the ups and downs of start-ups. Her blog’s focus is on money and personal finance, technology, and entrepreneurial endeavors. Here’s a sampling of some recent posts:
3 Ways To Fund Your Business: How To Finance A Startup For The Best Growth
Who Cares About Sex, Money and Personal Finance? What Google Trends Are Telling Us
5 Ways To Survive A Volatile Stock Market

Obesity in Workers Comp: Duke Sounds the Alarm

Tuesday, April 24th, 2007

Duke University recently published a study of its own employees, which found a significant link between obesity and the cost of workers compensation. The analysis found that obese workers filed twice the number of workers’ compensation claims, had seven times higher medical costs from those claims and lost 13 times more days of work from work injury or work illness than non-obese workers. Although these are alarming numbers, the practical implications for American employers are not entirely clear.
The researchers looked at the relationship between body mass index (BMI) and the rate of workers’ compensation claims. Because the BMI takes into account both a person’s height and weight, it is considered the most accurate measure of obesity. For Americans, a BMI of 18.5 to 24.9 is considered normal; 25 to 29.9 is considered overweight, and 30 and above is considered obese. (You can calculate your own BMI here.)
The researchers zeroed in on employees with a BMI greater than 40. That is way up on the scale (so to speak). These employees had 11.65 claims per 100 workers, compared with 5.8 claims per 100 in workers within the recommended range. (With these incident rates, Duke may receive a letter from OSHA as a “high frequency” employer. See our blog here.)
Some of the numbers are truly alarming: in terms of average lost days of work, the obese averaged 183.63 per 100 employees (that makes lumberjacks look good!), compared with 14.19 per 100 for those in the recommended range. Yikes! The average medical claims costs per 100 employees were $51,019 for the obese and $7,503 for the non-obese. These are huge differentials.
The disparity between the obese and the “normal” is so large, it raises some questions that the press release simply doesn’t address. How many people meeting the definition of obese were included in the study? Were the trends truly “average” – or did a relatively small number of outlier claims magnify the disparity? Perhaps most important, how well does Duke manage its injured workers? How effective is their return to work/stay at work program? Are they able to accommodate injured employees, whether obese or not?
As you would expect from an academic institution, Duke recommends a proactive approach. Truls Ostbye, a professor of community medicine, says the following:

Given the strong link between obesity and workers’ compensation costs, maintaining healthy weight is not only important to workers but should also be a high priority for employers. Work-based programs designed to target healthful eating and physical activity should be developed and then evaluated as part of a strategy to make all workplaces healthier and safer.

I’m sure some less enlightened employers might be inclined to come up with a simpler solution: fire anyone who is obese. (These workers may or may not be protected under the Americans with Disabilities Act. It’s a gray area that we’ve looked at in the past.) But realistically, obese people are valuable contributors in many workplaces. It’s neither practical nor desirable to exclude them simply on the basis of their size.
Ultimately, the calculus of employment has to take in a number of key factors:
– the work performed
– the motivation of the employee
– the inherent risks in the work
– the employee’s willingness to tackle what is ultimately a personal problem
As a company specializing in the control of workers comp costs, Lynch Ryan focuses on the looming challenges for American employers: an aging workforce. undocumented workers with few transferable skills, the lack of conventional health insurance. Obesity certainly belongs on the short list of big challenges. The Duke study may or may not reflect the true cost of obesity to employers across the country. But the alarm has been sounded. Prudent employers will analyze their own situations and take action to mitigate the risks.

Health Wonk Review #30

Friday, April 20th, 2007

Jason Shafrin has posted Health Wonk Review #30 at Healthcare Economist – some good end-of-the week reading. Some of the prevailing these in this issue are HSAs and managed care, physician incentives, and the Massachusetts health insurance experience. And check out some other postings on the site too – if you care about healthcare policy, Jason’s blog should be on your short list of must-reads.

Thoughts in the aftermath of a tragedy

Wednesday, April 18th, 2007

Our hearts go out to the Virginia Tech community in their time of mourning. What a terrible event and what a sad reminder that life is short and and can be snatched from us and those we love at any moment in the most unlikely of circumstances. Perhaps the best memorial we can offer to the deceased is to redouble our efforts to live with kindness and goodwill. That, and to reach out and hug our loved ones.
Be alert for your employees’ reactions to this event. A horrible incident like this can take a psychic toll on many – even those who are remote observers with no actual connection to the event can suffer emotional stress. This is particularly true for those who have previously been involved in episodes of violence. Events of this nature can rekindle or exacerbate post-traumatic stress disorder for people unrelated to the actual event. For others, it can bring repressed fear and anxiety to the surface. The continual media drumbeat 24/7 and focus on sensational details can add to general distress.
In the aftermath of this and other horrors, we seek to make sense of senseless events. It’s natural that many would look to find someone or something to blame beyond the deceased perpetrator. Right now, many are looking to the university’s security procedures and questioning why the campus wasn’t locked down after the first shooting. That’s a valid question. Of course, it’s easy in hindsight to say what should have been done, but the reality can be more complex, so we will need to wait for the investigation to answer this and many other questions. Certainly, Columbine delivered some hard lessons about how things could have been handled better to minimize loss of life. Recommendations from follow-on Columbine investigations have been adopted by law enforcement personnel nationwide, and may already have saved lives.
The psychology of security
Can a community of 30,000 ever be securely locked down against a deliberate and cunning killer? Bruce Schneier presents a sober look at the issues of risk management and security in his excellent article, The Psychology of Risk. He points out that security is both a mathematical reality that can be calculated and a feeling based on psychological reactions to both risks and countermeasures. In regard to the latter, he notes:

* People exaggerate spectacular but rare risks and downplay common risks.
* People have trouble estimating risks for anything not exactly like their normal situation.
* Personified risks are perceived to be greater than anonymous risks.
* People underestimate risks they willingly take and overestimate risks in situations they can’t control.
* Last, people overestimate risks that are being talked about and remain an object of public scrutiny.

He goes on to present several examples of how and why people exaggerate some risks and downplay other risks, often in complete disregard to the mathematical realities. These perceptions influence our expenditures of time and effort:

“Why is it that, when food poisoning kills 5,000 people every year and 9/11 terrorists killed 2,973 people in one non-repeated incident, we are spending tens of billions of dollars per year (not even counting the wars in Iraq and Afghanistan) on terrorism defense while the entire budget for the Food and Drug Administration in 2007 is only $1.9 billion?”

Noting that absolute security is an impossibility, Schneier frames the matter of relative security as a trade-off. We measure the time, expense and inconvenience of a given security measure against our perception of the risk. If that perception is faulty, it’s an irrational trade off that doesn’t do much to increase our security.
After a tragedy, emotion often prevails over dispassionate rationality. Thus we can’t carry shampoo on planes and we strip down to almost our skivvies in airports. Does that make us safer or does it just make us feel safer? It’s unlikely that any measures can be thorough enough to guard us from a random determined killer in our midst. Efforts might be better spent trying to determine the root causes of why there are so many random determined killers in our midst.
Schneier’s article presents interesting, well-framed ideas in well-written format. Whether you work in the business of risk or just live in a risky world, it’s worth a read.

The Scarlet O: OSHA’s List of Unsafe Employers

Tuesday, April 17th, 2007

We recently blogged the publication of OSHA’s list of 14,000 employers with “high” workplace injury and illness rates. One of the links posts the list as an Excel spread sheet, so you can search, state by state, to find the names of frequent flyers.
But what exactly does the list tell us? Is it automatically an indicator of a safety-deficient employer? Is OSHA handing out “the Scarlet O“?
In their own press release, OSHA backpedals from the start. While they are publicizing their list of 14,000 workplaces with “high” injury and illness rates, they are quick to add that help (OSHA itself) is readily available. OSHA states that the notification “was a proactive step to motivate employers to take steps now to reduce those rates and improve the safety and health environment in their workplaces.”
“This identification process is meant to raise awareness that injuries and illnesses are high at these facilities,” said Assistant Secretary of Labor for OSHA Edwin G. Foulke, Jr. (You may remember Foulkie from a prior blog on fatality rates. He is still presumably doing a heck of a job.) “Our goal is to identify workplaces where injury and illness rates are high and to persuade employers to use resources at their disposal to address these hazards and reduce occupational injuries and illnesses.”
So OSHA has pointed a finger at a few thousand employers. Just how should they take this news?
Inadequate Data
OSHA uses employer-reported data from 2005. The 14,000 workplaces identified had 5.3 or more injuries or illnesses resulting in days away from work, restricted work activity, or job transfer (DART) for every 100 full-time workers. The national average for all industries during 2005 was 2.4 DART instances for every 100 workers.
There are a few problems with OSHA’s data:
First, the information, because it is self-reported, is not very accurate. Many employers have no clue how to fill out the forms. They make a lot of mistakes. (For the most part they err on the side of omission, rather than over-reporting their rates.)
Second, some employers are over-zealous in their own reporting. They report everything, which may give the appearance of higher-than-average rates, but really reflects higher-than-average safety awareness (especially in regard to incidents that do not result in lost time).
Third, the data lumps too many items together: they include not just incidents resulting in days away from work (the most reliable indicator of safety issues), but incidents requiring modified duty or job transfer. That’s a very broad net.
Finally, a single incident rate for all industries is pretty meaningless. The rates should be industry specific.
Even as they publish this somewhat embarassing list, OSHA is not concerned enough to schedule visits to the violators. Later this year they will announce a “limited” number of companies for targeted inspections.
If OSHA is really serious about profiling high risk employers, they need to do some more homework. For starters, they could lobby their fellow feds at the Bureau of Labor Statistics (BLS) to revive the data collection effort that came to an abrupt halt in the early 1990s. BLS used to publish some very useful and compelling data, including the average number of lost workday cases and case rates by specific industry. Those benchmarks were extremely helpful for employers trying to answer the key question: How are we doing relative to others in our same type of business?
OSHA as Officer Friendly?
Mr. Foulke’s tenure at OSHA has been characterized by a lot of platitudes and not much in the way of enforcement. We are in an era of “self-enforcement” – which works for some and does not work at all for others. Here’s a quote from a speech Foulke gave to the national tower erectors association:

Here is an analogy anyone can relate to: When you see a police officer on a street corner, you are not afraid of him. You might even go up and ask for directions and you’ll be grateful for the advice. However, you are also aware that if you run a red light, that same friendly, helpful police officer will issue you a ticket that could result in your paying a hefty fine for breaking the law. This is how I want all employers to think of OSHA.

Hmm, OSHA as Officer Friendly. If you belong to a racial minority, or if you are an undocumented immigrant, you might well be afraid of the cop on the corner. In many instances, you would be too afraid to ask his advice. In addition, if you did run the red light, you might or might not get a ticket. Those in powerful places have ways to make those tickets disappear, while most of us have no option but paying the fine. The analogy is a bit more complicated than Foulke would admit.
When we think of OSHA in its current form, we see the federal agency responsible for workplace safety pandering to the powerful, whether safety conscious or not, and ignoring the interests of the worker. The agency, driven by hard-line ideology, is out of balance.
In the final analysis, can we do anything useful with OSHA’s list of 14,000 “high frequency” employers? Probably not. OSHA’s “Scarlet O” is neither a badge of shame nor honor. It doesn’t mean much of anything. It’s really just a big fat zero.

News roundup: Job strain & diabetes, the costs of conflict, short takes, the lighter side

Monday, April 16th, 2007

Medical risk factorsOccupational Hazards features a report on a study in the April Journal of Occupational and Environmental Medicine that links job strain to high blood pressure. Job strain is defined as “high psychological demands combined with low control or decision-making ability over one’s job.”
Is litigation the answer? – Stewart Levine goes into some detail about the many costs of conflict in Law Practice Today, pointing out that “Twenty percent of Fortune 500 senior executives’ time is spent in litigation-related activities.”
Judge Robert Vonada of Pennsylvania Workers Compensation Journal cited this article as a “valuable resource for parties to understand the process and benefits of mediation.”
Worker Memorial Day – Tammy Miser at Weekly Toll reminds us that Worker memorial is upcoming on April 28. She also offers a history of the event and how it came to be.
Quick takes

The lighter side

Health & Safety news notes – asbestos, office seating, OSHA resources

Friday, April 13th, 2007

Federal workers exposed to asbestosEffect Measure points to the a story in the Washington Post about the plight of 10 employees of the Architect of the Capital who have been exposed to asbestos for a number of years. These workers toil in underground tunnels strewn with asbestos debris, and have complained about working conditions over a number of years. Now, in what they see as retaliation for their complaints, they are being transferred to an active asbestos removal project at a power plant. Hopefully, this public airing will help to provide some help for these workers, most of whom are demonstrating lung scarring from years of exposure. (Thanks to our friend Joe Paduda for the pointer.)
Addendum 4/17/07: a former New York City employee mailed this note to us related to the above:

“Thank you for posting the story of the workers for the Architect of the Capital. I have had the same experience as an employee of the city of New York. I worked for years removing asbestos from city hospitals. After being hospitalized with asbestos related lung disease and filing a claim for workers compensation, I was assigned to a more hazardous location and assigned to oversee asbestos abatement projects. I informed my employer that the conditions I was working under were further damaging my condition and attached a letter from my doctor to that effect. Their response was to leave me in a dangerous environment for another five weeks and then fire me for not being able to preform the functions of my job.”

Ergonomic seatingErgonomic Office Chairs Health Hub is a comprehensive resource on ergonomic office chairs and seating options, providing information on how to set up an ergonomic chair and computer workstation, and alternative seating options. It’s affiliated with, a peer reviewed medical journal for patients with back pain and spinal disorders, written by physicians who specialize in spine medicine. There are some good articles on related topics, such as choosing the right chair, tips for improving posture, and pain-free travel tips. We’ll add this link to our sidebar resources.
OSHA initiatives