Archive for July, 2008

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Buried alive

Tuesday, July 15th, 2008

What could be more horrifying than the idea of being buried alive? It’s the stuff of nightmares. novels, and scary movies, tapping into one of our most primal fears. Yet unfortunately, buried alive is not just the stuff of fiction. Every year, it’s the same old story – collapsing trenches kill workers at both commercial and residential work sites. Deaths are sometimes caused by asphyxiation or drowning when trenches fill with soil or water. It’s also quite common for workers to die from being crushed by the sheer weight of the soil – which can exert pressure of more than two tons per cubic foot of dirt. Sometimes, workers are alive and talking while they are being rescued only to die during or shortly after the rescue, succumbing to injuries from the sheer pressure of the weight, which compresses the chest and cuts off oxygen to muscles and extremities.

News reports often focus on desperate rescue efforts with co-workers and emergency crews frantically digging to free a trapped colleague – yet many of the deaths happen when workers jump in an unsecured trench to try to save a colleague and a secondary collapse occurs. Trench rescues require speed and expertise – trained rescue workers understand the risks to both the endangered worker and to rescue workers. Before a rescue can safely occur, the site must be secured – something that should have happened before the collapse. Time is critical because even when a worker’s head or upper torso is visible, irreversible crushing injuries can occur in less than 10 minutes.

These are immensely frustrating deaths because they are preventable with proper safety precautions – but all too often, time and budget trump safety. Breathless news coverage often refers to the accidents as freak events but that implies that the event couldn’t have been anticipated or prevented. Unfortunately, there is nothing unusual about the collapse of an unsecured trench – without proper safety precautions, any excavation over 5 feet which is deeper than it is wide is a problem waiting to happen.

Workplace trench safety: Related resources and postings

OSHA – Trenching and Excavation
OSHA Trench Safety Quick Card (PDF)
OSHA Confined Spaces
Excavations: A guide to safe work practices – 20 minute video clip from WorkSafeBC
Trench safety publications and information

Call Before You Dig – resources for nonprofessionals

In addition to being at risk for trench collapses, the do-it-yourself who tackles home improvement projects may face electrocution and other risks when digging is involved. A new, federally-mandated national Call Before You Dig 811 number was created to help protect homeowners from unintentionally hitting underground utility lines while working on digging projects. In addition, each state has
different rules and regulations governing digging, some stricter than others – state-by-state requirements can also be found at the 811-dig link.

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Disability Fraud Closer to Home

Monday, July 14th, 2008

Last week we blogged the widespread abuse of “disability” pensions for able-bodied members of Zimbabwe’s ruling elite. Several cabinet members sported 100% impairment ratings – “quadraplegics” – even as they routinely tootled around the capital in their armored Mercedes and ran up a marbled staircase to greet their esteemed leader, Robert Mugabe.
Veteran reporter Walter Robinson of the Boston Globe brings the story of bogus disability a lot closer to home: Boston firefighter Albert Arroyo claimed to have fallen in the firehouse on March 21. His application for disability retirement states that “while descending the stairwell Engine 28’s quarters’s (sic), I tripped on a loose staircase casing (sic) me to slipped.” Literary talent aside, Arroyo suffered such a severe back injury that his (unnamed) doctor rated him as “totally and permanently” disabled and eligible for a generous, tax free disability retirement.
On May 3 Arroyo felt a lot better. He finished eighth in a men’s body-building competition, the 2008 Pro Natural American Championships. (If still available, you can see some adorable videos of Arroyo prancing and posing at Boston.com.) Arroyo’s lawyer (yes, he will need counsel) has said that “bodybuilding helped him cope, emotionally and physically, with the travails and rigors of working as a firefighter.” Heck, I recommend bodybuilding to every person who is permanently and totally disabled. It will do wonders for their self-esteem.
Corrupt Medicine?
This sorry tale highlights the role of doctors in establishing permanent disability. You don’t get a disability pension based upon a note from mom. In this case, Arroyo’s unnamed doctor said he had been seeing Arroyo for back problems since 2000. He attested to the severity of the injury, but when contacted recently by the Retirement Board, he claimed that he was unaware of the bodybuilding history. On June 21 he wrote: “This information was not known to me until your letter and I will therefore proceed accordingly when evaluating Firefighter Arroyo in follow up.” You have to wonder whether the prodigiously muscled Arroyo ever took his shirt off in the doctor’s office.
And by the way. Arroyo, a firefighter since 1986, does not have to carry people from burning buildings. He is assigned to the Fire Prevention Division – which makes his inability to perform his job all the more suspect.
Robinson’s article highlights widespread abuse of disability retirements in the Boston Fire Departement. Senior commanders routinely retire on inflated pay: district chiefs “fill in” for Deputy Chiefs. If disabled while filling in, they retire on the salary of the Deputy. John Ellard, a district chief, suffered a “career-ending back injury” during a fire while filling in for a deputy. Fifteen days later, he went to Ireland on a long-planned vacation. He is now collecting $89,532 tax free for the rest of his life.
No one begrudges the disability pensions awarded to truly disabled firefighters. It’s obvious, however, that some of the folks retiring on disability in Boston are no more impaired than the cabinet members in Zimbabwe. Shame on the firefighters, along with the doctors and unions who enable them. As for Mr. Arroyo, the next time he sees his doctor, he should take off his shirt and do some posing. That will be the end of his disability rating.

Posted in Disability | 2 Comments »

Disability Ratings with a Heart of Darkness

Thursday, July 10th, 2008

Imagine that you are a doctor participating in a compensation review board for wounded veterans. You are responsible for signing off on pensions that have been recommended by a politically connected doctor. Frequently, the diagnosis is “polyarthritis” and the disability rating is 85%. At first, your review committee is fully staffed, but the pressure to endorse the blatantly bogus claims is intense. Soon, only two doctors remain. You and your colleague sit together for long hours, re-examining “wounded” veterans and challenging hundreds of claims. As you reject one phony applicant after another, the doctor signing off on the original applications threatens you with bodily harm.
You cannot turn to the government for support, because senior members of the ruling party are collecting disability payments. The doctor determining the absurd ratings heads the War Veterans Association and has given himself a rating of 85% for “polyarthritis.” He is so well connected, the country’s president has invited him into the Cabinet (where a number of his fellow cabinet members, moving with no evident difficulty, have been classified as quadriplegics with disability ratings of 100%).
Where are we? What nightmare of a country operates in this fashion? We are in the tragic land of Zimbabwe, formerly Rhodesia. The doctor is writer Peter Godwin’s mother, who has spent much of her life in Africa, struggling heroically to provide medical care to her impoverished patients. Her colleague, up until her retirement from the review board, was Dr. Edwin Mhazo. Alas, he died very suddenly, under mysterious circumstances.
The head of the veterans association and cabinet member who leads the corrupt drive for phony pensions is Dr. Chenjerai “Hitler” Hunzvi, who sat out the war for independence in Poland, well out of harm’s way, but who returned after Robert Mugabe assumed (total) power. In 1997, when the government ran out of money to pay wounded veterans (some truly disabled, many not), Hunzvi led street demonstrations. Mugabe caved to the protesters, offering huge lump sum settlements and generous monthly payments to 50,000 war vets. The Zimbabwe dollar collapsed, never to recover.
NOTE: Godwin’s fascinating memoir, When a Crocodile Eats the Sun, is available in paperback. Highly recommended.
The Politics of Disability
The thousands of practitioners who work in disability-related fields in this country take a lot for granted. The vast majority work with integrity and genuine compassion. We all recognize the importance of accurate disability ratings. When there are disagreements between insurance companies and claimants, the courts offer a complex but reasonably consistent “due process” to ferret out the truth. The system is not always fair and the outcomes on individual cases can be truly bizarre, but on the whole the results are within reasonable parameters.
What we see in Zimbabwe is a parody of the process: a totally corrupted means of securing wealth for people who do not deserve it. It is a compelling reminder that all social interaction is based upon good faith. When that faith is stripped away, when hearts of darkness prevail, good people and the values they embody are very much at risk.

Posted in Disability | 2 Comments »

Heat stress: rules, reports, and resources

Wednesday, July 9th, 2008

Here in the Boston area, we approach another 90+ degree day and the air is thick and muggy, prompting air quality alerts. But that’s nothing compared to the heat in California where outdoor workers struggle in 104 degree temperatures, with things are even worse for the firefighters who battle to control rampaging fires. Triple digit temperatures have triggered the state’s heat emergency plan. California is one of two states – Oregon being the other – that has issued mandatory heat stress rules to protect outdoor workers. According to California’s Division of Occupational Safety and Health, employers were fined $828,440 last year for failing to comply with these rules.
CDC report: heat fatalities in crop workers
The CDC recently released an important report on Heat-Related Deaths Among U.S. Crop Workers, 1992–2006. During this 15-year period, 423 workers in agricultural and nonagricultural industries were reported to have died from exposure to environmental heat. The heat-related average annual death rate for these crop workers was 20 times higher than for other workers, or 0.39 per 100,000 workers, compared with 0.02 for all U.S. civilian workers. The majority of these deaths were in adults aged 20 to 54 years, a population not typically considered to be at high risk for heat illnesses. And in the dubious distinction department, North Carolina leads the nation in heat-related crop worker deaths.
Employer best practices
The following are best practices for employers with outdoor workers:

  • Train employees and supervisors in heat illness prevention, as well as how to recognize the symptoms of heat-related illness and what to do if someone exhibits symptoms
  • On days when temperatures require preventive measures, increase the volume of water available to employees. California suggests one quart per hour. It is not enough to simply provide it – workers must be encouraged to drink the water.
  • Have shade available for outdoor workers and allow frequent breaks – at least 5 minutes of rest when an employee believes they need a preventative recovery period.
  • Have the ability to appropriately respond to any employee with symptoms of illness
  • Allow gradual acclimation for workers unaccustomed to working outside – it can take 4 to 14 days
  • Know where the nearest hospital is and directions to your work site in case emergency medical attention is needed

Heat-related resources

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Of Wage-Earning Capacity and Human Wreckage

Tuesday, July 8th, 2008

Ronnie Ramroop was an employee of Flexo-Craft Printing in New York. In March of 1995 he caught his hand in a press, crushing four fingers. After seven surgeries, two fingers were amputated. It goes without saying that this is a work-related injury; workers compensation paid the medical bills, loss of function benefits (Ronnie lost 75% of the use of his hand), along with indemnity for lost wages. Ronnie received benefits through January 2000, at which point his eligibility ended.
Ronnie then applied for the “additional benefits” available under New York law. To receive these benefits, Ronnie had to prove that the impairment to his wage-earning capacity was due solely to the work-related injury. That’s where Ronnie’s claim hit a big snag: Ronnie is an undocumented worker. Yes, his inability to work is connected to his rather severe injury, but it is also related to the fact that he is not qualified to work in this country. As the court put it, Ronnie’s appeal puts into clear focus the tension between the statute’s voc rehab objective to return an injured worker to the marketplace and the re-employment of a worker who is not allowed to work. Some tension, indeed!
The NY Court of Appeals, in a 5 to 1 vote, has denied Ronnie’s claim for additional benefits. They concluded that it was not the Legislature’s intent to “restore to re-employment” a worker who cannot be lawfully employed.
The Lone Dissent
The dissent by Justice Ciparick raises an interesting issue. The judge quotes Chief Judge Cardozo, who emphasized the humanitarian purposes of the comp statute, with its goal of ensuring that injured employees “might be saved from becoming one of the derelicts of society, a fragment of human wreckage.” Judge Cipatrick believes that the right to full benefits should be considered an absolute, unrelated in any way to a worker’s immigration status. For this (dissenting) judge, there are no tiered benefits. All workers are entitled to all the benefits.
Virtually all the comp statutes in the US were drafted before the issue of undocumented workers became visible. A number of states have begun to step into the documentation and enforcement void created by a paralyzed Congress: they are drafting punitive laws on the hiring of undocumented workers (and thus giving rise to great concerns among American businesses). Some of these same states are toying with the idea of curtailing comp benefits for undocumented workers. This would be the final step in the creation of a truly third-class workforce, with sub-standard working conditions, wages and protections. We will have come full circle, with the fears of Judge Cardozo fully realized: millions of essential jobs performed by a marginalized workforce – derelicts of society, fragments of human wreckage.

Posted in Compensability, State News | 2 Comments »

Cavalcade of Risk; WC and hospital profits; poultry industry expose

Wednesday, July 2nd, 2008

It’s Cavalcade of Risk day, and Louise Norris has an Independence day edition posted at Colorado Health Insurance Insider. Louise and her husband Jay have an interesting story about how they came to the field of health insurance: literally, through the school of hard knocks after intersecting with the health care industry through personal experience, a series of sports-related injuries. Today, as a locally-owned Colorado brokerage, they are respected health insurance consultants. One nice thing about the web is how an informative site such as theirs can serve as a great equalizer for smaller entrepreneurial firms – if you live in Colorado, they sound like great people to do business with.
Meanwhile, check out today’s edition. There’s a lot of good reading material linked – be sure to catch Nancy Germond’s entry on writing a workplace incident report and Joe Paduda’s entry on the horrors of universal coverage. And while over at Joe’s place, also see his post on workers comp – the hospital profit engine – it’s a real eye opener. Here’s a teaser: “The entire US hospital industry generated profits of roughly $25 billion, workers’ compensation – which you will remember represents only about 1.5% of total hospital revenues – accounts for approximately 16 percent of all the profits for US hospitals.” He follows this post with another on DRGs, Medicare, hospitals, and workers comp, where he delves into further explanation for the costs. If you work in workers comp or managed care, these are must-read posts.
Bill Moyers on the poultry industry and worker safety – We’ve blogged several times about the appalling state of safety in the poultry and meat packing industries. This year, there has been a concerted focus on the poultry industry, largely thanks to the excellent investigative journalism in the Charlotte Observer’s The Cruelest Cuts, a six-part multimedia series – well worth exploration if you missed it first time around. Now, Bill Moyers has picked up the ball, covering the topic in a 22 minute investigative report of the poultry industry (video clip), which shows how official statistics showing a drop in workplace injuries may have been the result of deceptive reporting. See much more information on poultry worker safety at Bill Moyers’ Journal on PBS.

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ADA: The Fix is Fixed

Tuesday, July 1st, 2008

Back in February we blogged a rather drastic proposal to “restore” the Americans with Disabilities Act (ADA) by expanding eligibility to just about anyone. We feared that blurring the lines between transient conditions and impairments that “substantially limit” major life activities would paralyze American business, clog the courts with trivial cases and divert attention away from the truly disabled, who desperately need ADA protection.
Well, it appears that the “restoration” has been restored and the “fix” has been fixed. Proposed reforms would expand coverage where the U.S. Supreme Court had curtailed it: individuals whose disabilities can be treated – with medication, with prosthetic devices, with assistive technology – would still be considered disabled. In other words, their ADA protection would not end simply because their disability is mitigated through some form of treatment. (Got that, Justice Thomas?)
The fix also addresses the paradox of “regarded as” disability. This involves situations where an individual is discriminated against because he or she is perceived to have an impairment: “Jack looks like an alcoholic.” These people do not require accommodation (they are not really disabled), but the ADA will ensure that they are not discriminated against based upon a false perception.
Formidable Support
While disagreement on the nature of disabilities will continue, substantial agreement has been reached on language for the revised ADA statute. Here are some of the organizations that have signed off on the proposed revisions:
– American Association of People with Disabilities
– American Diabetes Association
– Bazelon Center for Mental Health Law
– Epilepsy Foundation
No surprises there. But check out some of the mainstream business organizations that are also on board:
– National Association of Manufacturers
– National Restaurant Association
– US Chamber of Commerce
With such diverse and powerful backing, the ADA fix appears to be headed for passage. That’s all well and good. But as we pointed out in February, there is a sad paradox in the ADA itself: since the law was enacted in 1992, overall levels of employment for the disabled have declined. Employers, intimidated by the law’s many requirements, apparently take the path of least resistance and avoid hiring qualified disabled applicants. So in some respects the ADA “fix” compounds the problem. The real fix goes beyond the language of this or any other law: it involves transcending stereotypes and embracing people for who they really are and recognizing what they are truly capable of doing.

Posted in Best Practices, Disability | 2 Comments »

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