California fires: Response and recovery health hazards

October 25th, 2017 by Julie Ferguson
A firefighter working in the California fires

Photo: Mike Blake / Reuters

In the wake of the devastating California fires, the massive debris field – formerly neighborhoods, homes and businesses – is now a toxic environmental brew that poses risks to cleanup and recovery workers and residents alike. Kirk Johnson discusses the environmental and health risks of the California fire cleanup in an article in the New York Times.

“In modern times this has got be an unprecedented event, and a major hazard for the public and for property owners,” said Dr. Alan Lockwood, a retired neurologist who has written widely about public health. He said an apt comparison might be the environmental cleanup after the terrorist attacks of Sept. 11, 2001, in New York, as debris and dust swirled through Lower Manhattan.

As could well happen too in California, Dr. Lockwood said, the health and environmental effects were felt long after the attack, in the chemicals or pollutants workers and responders at the site, and the public at large, may been exposed to as the cleanup went on.

The scope of the fire disaster in California is hard to comprehend:  Photos Capture Apocalyptic Aftermath Of California Wildfires. Also: and the Los Angeles Times Mapping the destruction from California’s wine country fires.

We’d be remiss if we didn’t offer a tribute to the 9,000+ hard-working firefighters on the front lines who risked life and limb to contain the fires, rescue people and save property. See NPR’s story by Eric Westervelt: In Northern California, Exhausted Firefighters Push Themselves ‘To The Limits’.

See the Atlantic‘s In Focus for a display of photos that document the danger and the destruction.

One interesting and little known aspect of the battle against the fires is that 30-40% of the firefighters battling the fires were prisoners, according to Mother Jones. About 4,000 low-risk prisoners save the state about $80 million a year. Inmates are volunteers who are trained in a four-week program, receive $2 an hour and earn a 2-day sentence reduction for every day served. Typically, they are low-risk felons.

“Career firefighters do things like flying in helicopters and driving bulldozers; inmate firefighters use hand tools, like chainsaws, axes, and rakes, to contain the fire by clearing out the vegetation around it. The prisoners participate in a four-week training process—the same process that other state firefighters go through—proving that they’re fit enough to work through brush in the heat of a fire while carrying up to 100 pounds of gear. They work in teams of about 15 people, supervised by a fire captain. When there’s a big fire blazing, the teams work in shifts of 24 hours, followed by a 24-hour break. When not tending fires, the inmates do other conservation work, often clearing brush to prevent future fires.”

Jaime Lowe of the New York Times reports on The Incarcerated Women Who Fight California’s wildfires. It talks more about how the program works and takes an up-close look at some of the female inmates on the front lines, including the very real risks they take. While many tout this as a win-win for both the state and the inmates, there are many limitations in terms of the rehabilitative value. Lowe says:

“C.D.C.R. says that the firefighter program is intended to serve as rehabilitation for the inmates. Yet they’re being trained to work in a field they will probably have trouble finding a job in when they get out: Los Angeles County Fire won’t hire felons and C.D.C.R. doesn’t offer any formal help to inmates who want firefighting jobs when they’re released.”

Further in the article, Lowe talks more about this:

When I visited Rainbow, I asked a Cal Fire captain named Danny Ramirez why the state wouldn’t increase the incentive to join the program by paying even a little bit more. He didn’t have a ready answer. Which brought up another puzzling aspect of the program: Why doesn’t the state get more out of its investment in training these women by hiring them when they’re released? Or at the very least, by creating a pathway to employment? Ramirez said the idea ‘‘to keep tags on the girls’’ had come up before. ‘‘Some of these girls leave very interested in what they got exposed to and say, ‘Oh I never knew this exists, how do I keep on doing this?’ And it’s hard when they get out there because they do have a lot of the same walls that they were facing before. But a program to keep them guided and keep them on that path and keep them focused on something instead of getting back into their old ways or old friends would be awesome.’’

 

Health Wonk Review’s “Pink Edition”

October 12th, 2017 by Tom Lynch

InsureBlog’s Hank Stern has posted the latest edition, the “Pink Edition,” of Health Wonk Review.

Why the “Pink Edition?” Because October is National Breast Cancer Awareness Month, and Hank and his team, Love, Hope and Faith, are doing their best to raise money to help eradicate this terrible disease. They’re participating in a walk to do just that on October 21, and Hank would love some help from the HWR community. Something to think about.

So, after making a donation to Hank’s worthwhile cause, we hope you’ll grab a cup of whatever suits you best, put your feet up and once again revel in all things health wonkery.

Workers’ Comp as Percentage of Payroll: NASI Report

October 10th, 2017 by Julie Ferguson

The National Academy of Social Insurance (NASI) recently issued its 20th annual report on Workers’ Compensation: Benefits, Coverage, and Costs. The study provides estimates of workers’ compensation payments—cash and medical—for all 50 states, the District of Columbia, and federal programs providing workers’ compensation.

The study showed that

  • Benefits per $100 of payroll fell from $0.92 in 2014 to $0.86 in 2015, the lowest level since 1980.
  • Workers’ compensation employer costs per $100 of payroll dropped to 1.32 in 2015, reversing consistent growth that began after the recession.
  • In 2015, workers’ compensation coverage extended to an estimated 86.3 percent of all jobs in the employed workforce, comprising more than 135 million workers.

Study authors say the drop partly reflects improved workplace safety. Also noteworthy:

“Both the incidence and severity of work-related injuries have declined steadily since 1990. In fact, according to the Department of Labor, the proportion of workers who experienced injuries that resulted in days away from work reached a 25-year low in 2015.”

The study encompasses state-by-state changes in coverage, benefits, and employer costs over the last five years. The state-level results show that between 2011 and 2015:

  • The number of covered workers increased in every state except West Virginia, with 11 states experiencing double-digit growth in covered employment;
  • The amount of covered wages increased in every state, and by more than 20 percent in 16 states;
  • Benefits per $100 of payroll decreased in all but three states, with the biggest declines in Illinois (-$0.33), Oklahoma (-$0.41), and West Virginia (-$0.52)—three states that implemented significant changes in their workers’ compensation systems during this period;
  • Employer costs per $100 of covered payroll increased in 24 states and decreased in 27 states. West Virginia, Montana, and Oklahoma experienced the largest reductions, with costs dropping more than $0.30 per $100 of covered payroll. Employer costs increased by more than $0.20 in Wyoming, Delaware, and California.

NASI workers comp infographic

News Roundup: Health Wonk Review and noteworthy news from around the web

September 28th, 2017 by Julie Ferguson

A fresh Health Wonk Review is hot off the press and the word for the day is “fatigue.” The 3rd congressional attempt at Affordable Care Act repeal ground to a halt last week after it became apparent that there weren’t enough votes in the the Senate to get it over the finish line. Brad Wright hosts this week’s Health Wonk Review: Repeal Fatigue Edition at Wright on Health, with wonks weighing in. But if you don’t want to read about ACA, never fear – the wonks weigh in on other health policy issues, too.

Here’s some other recent news that caught our eye:

NCCI: The Marijuana Conversation: What’s Next – Medical marijuana is currently legal in 29 states, as well as Washington, DC. It’s also legal for recreational use in eight states and Washington, DC. However, marijuana is still illegal at the federal level and is classified as a Schedule I drug under the federal Controlled Substances Act. NCCI’s “Marijuana Conversations” series explores questions from workers compensation insurers, employers, employees, regulators, and legislators. Each face unique challenges, complexities, and implications.

MSHA – David Zatezalo, Trump’s nominee for assistant labor secretary in charge of the U.S. Mine Safety and Health Administration, is a former coal exec whose mines logged a “pattern of violations.” It raises more than a few uneasy hen-guarding-the-chicken-coop questions about his appointment. His latest critic? Manchin will oppose Trump mine safety nominee, as per Ken Ward Jr. at the Charleston Gazette-Mail.

Dairy Workers: Suffocating in Manure – Jordon Barab of Confined Space talks about a recent Washington Post story on a truly horrific agricultural hazard, and just one of many. “There were 6,700 injuries on dairy farms with more than 11 employees in 2015 — a rate more than double the average for private industries. On those farms, 43 laborers died.” Barab notes that the article fails to mention that, “due to a 40 year old Congressional budget rider, OSHA is not allowed to set foot on farms that have ten or fewer employees. No inspections, even as a result of a worker complaint, and no investigation or citations, even if one or more workers is killed.”

Joe Paduda reports on a recent study by Princeton University’s Alan Krueger in his post at Managed Care Matters: Opioids responsible for a fifth of the decline in male workforce

Amid Opioid Crisis, Insurers Restrict Pricey, Less Addictive PainkillersNew York Time/Pro Publica

At a time when the United States is in the grip of an opioid epidemic, many insurers are limiting access to pain medications that carry a lower risk of addiction or dependence, even as they provide comparatively easy access to generic opioid medications.

The reason, experts say: Opioid drugs are generally cheap while safer alternatives are often more expensive.

Drugmakers, pharmaceutical distributors, pharmacies and doctors have come under intense scrutiny in recent years, but the role that insurers — and the pharmacy benefit managers that run their drug plans — have played in the opioid crisis has received less attention. That may be changing, however. The New York State attorney general’s office sent letters last week to the three largest pharmacy benefit managers — CVS Caremark, Express Scripts and OptumRx — asking how they were addressing the crisis.

Defending Against Cumulative Trauma – Roberto Ceniceros says that “Repetitive motion, or cumulative trauma injuries, stubbornly persist as generators of workers’ compensation claims and productivity losses year after year.” But remedies do exist – and he explores these in his article in Risk & Insurance.

Job loss due to medical care calendar vs. FMLA calendar – Dr. Jennifer Christian reminds physicians that they need to keep an eye in the calendar during worker recover, particularly in light of a recent court case.

Gig Economy Workers May See Benefits Relief – The Portable Benefits for Gig Economy Workers Act addresses a real need at a time when many people work in the gig economy and don’t have employer-provided benefits.

Quick takes

This Cat Is Dead. Let It Stay That Way.

September 22nd, 2017 by Tom Lynch

“Seriously. This is BANANAS” – Senator Chris Murphy, (D-CT), on Graham-Cassidy.

When I was in college I was part of a pretty successful folk group. We played all over, cut a few LPs. It was a great time. On college campuses we would sing a simple, little, nearly childish song that somehow actually became a bit of a hit. It was called The Cat Came Back.

Oh, the cat came back.
She didn’t want to stay.
She was sittin’ on the back porch
The very next day.

Well, there’s a new cat sittin’ on the porch, and it’s called Graham-Cassidy.

Every time we stick a fork in it and call it dead, a new zombie repeal and replace Obamacare horrendoma springs to life.

The selling point of this one, at least according to Senators Graham and Cassidy (and Vice President Pence yesterday morning on CBS), seems to be centered on the idea that passage of this bill will finally allow the states to plot their own health care futures.

That was also the position argued yesterday in a New York Times Op-Ed by Philip Klein, the Managing Editor of the Washington Examiner (Is this a coordinated effort?). In Graham Cassidy has One Great Idea Klein claims the different states have different healthcare needs and, consequently, should be able to address those needs through their own creativity rather than arbitrary requirements of  Washington.

A more flexible system would give states latitude to pursue healthcare programs that are a better fit for their populations’ ideological sensibilities. And there are practical reasons to think of healthcare as a state-based issue: Every one has its own demographics, health challenges and other unique characteristics.

“Ideological sensibilities?” Excuse me? Oh, well.

One thing that strikes me square in the jaw about the states rights argument is this: For the last 26 years, states have been able, with federal waiver approval, to craft their own Medicaid programs as long as the results are revenue neutral and comply with minimum requirements.

By way of explanation, Medicaid has been with us since 30 July 1965 when President Johnson signed it and Medicare into law. Medicaid has been a lifeline for the poor who, prior to the Affordable Care Act, were mostly uninsured for health care. The ER was their primary care physician. The Act had a number of goals, one of which was to lower the number of uninsured and underinsured Americans. Since these people were nearly all of the lower income variety, the Act provided federal funding for states to expand Medicaid. Thirty-one states plus the District of Columbia did that. And the numbers of uninsured dropped significantly in those states.

In 1991, the Social Security Act was amended to create federal waiver programs. States were given the authority, through what are known as Section 1115 waivers, to tailor their own Medicaid programs to their own population needs. As of September 2017, there are 33 states with 41 approved waivers and 18 states with 21 pending waivers. A subset of state waivers are aimed at healthcare delivery system reforms. They are known by the catchy title Delivery System Reform Incentive Payment waiversDSRIP waivers allow states to create innovative programs that reform how care is delivered and paid for. These are demonstration projects and come with federal funding. Lots of it. For example, one of Texas’s two DSRIP waivers, just concluded, provided $11.5 billion over five years. The Texas Health and Human Services Commission has applied for an extension and in May, 2017, submitted to the CMS its positive evaluation of the program’s results (Despite this deep drink at the federal trough, you might remember Texas’s very public, Alamo-like  rejection of federal money to expand Medicaid).

Personally, I think there are many reasons to bury the Graham-Cassidy cat so deep it never sees the sun again. Others have written and catalogued them (see America’s newest health care expert Jimmy Kimmel). But not much has been said to refute this ridiculous let-the-states-have-a-chance claim. The states already have, and have had for 26 years, autonomy to innovate and create programs, with the help of federal funding, that zero in on the needs of their particular populations within sensible federal limits. Graham-Cassidy would do away with those limits, significantly lower funding, force millions of our fellow citizens to become uninsured (again), drop the states down a deep well of chaos and put us all back in the wild west of health care.

Yesterday, in a highly unusual move, the Board of Directors of the National Association of Medicaid Directors (NAMD) issued a statement highly critical of Graham-Cassidy, saying it would place a massive burden on the states.

“Taken together, the per-capita caps and the envisioned block grants would constitute the largest intergovernmental transfer of financial risk from the federal government to the states in our country’s history.”

And last night, after learning of NAMD’s statement, Senator Chris Murphy (D-CT) tweeted, “You can’t get ALL 50 state Medicaid Directors to agree on anything else in health care. Seriously. This is BANANAS.”

America’s health care system is complicated (“Nobody knew healthcare could be so complicated!”) and full of inside baseball stuff. But it does allow states to chart their own destinies. So, here’s a question for Lindsay, Bill and Mike: What’s the real reason you’re trying so hard to resurrect this dead cat?

 

 

Taking Credit When It’s Due (And When It’s Not)

September 20th, 2017 by Tom Lynch

Politicians have proven over and over again to be the most adept people in the known universe at taking credit for good things happening with which they had absolutely no involvement and blaming others for bad things happening with which they were directly connected. Case in point is happening right now in the Hawkeye state of Iowa where workers’ compensation rates for 2018 are going down 8.7%.

About a nanosecond after NCCI announced the rate reduction, Republican Governor Kim Reynolds issued a press release claiming the rate decline to be the “direct result” of workers’ compensation legislative reforms that went into effect in July, which, if you happen to be counting, ended 51 days ago as I write this. Phew. That was quick.

Of course, while the new reforms may reduce costs in the future, they have nothing at all to do with the recently announced rate cut, which, according to NCCI, is predicated on a decrease in claim frequency and actuarial data from 2014 and 2015, which, if you’re still counting, is a full 18 months before the new reforms, to whose sticking post Reynolds has now glued himself.

It will be interesting to see, over time, if the new reforms reduce costs for Iowa’s employers and enhance care for its injured workers. That’ll be a neat trick for which Kim Reynolds can justifiably stand up and take a bow at some date in the future, say around 2019.

Here’s a little ditty to go out on:

It’s a little early for the Reynolds curtain call
But if things don’t work out, who takes the fall?

 

Automation Designed To Keep People Safe Can Produce The Opposite Result Through No Fault Of Its Own

September 18th, 2017 by Tom Lynch

A fascinating article in today’s Daily Alert from the Harvard Business Review describes how our dependence on automation can erode cognitive ability to respond to emergencies.

In “The Tragic Crash of Flight AF447 Shows the Unlikely but Catastrophic Consequences of Automation,” authors Nick Oliver, Thomas Calvard and Kristina Potocnik, professors and researchers at the University of Edinburgh Business School, report on their analysis of the horrific crash of Air France flight 447 in 2009. Their research, recently published in Organizational Science, describes in riveting detail the series of preventable cascading events that led to the deaths of all 228 passengers and crew.

Although the crash of AF447 is a transportation tragedy, it also can serve as a stark reminder that employees who depend on technology, especially technology that controls dangerous work, say self-driving 18-wheel trucks, for example, need a lot of training to take the right steps when technology reacts to emergencies. Without that training, the authors contend, the cognitive ability to take manual control and successfully deal with the emergency is problematic at best.

The authors provide an example:

Imagine having to do some moderately complex arithmetic. Most of us could do this in our heads if we had to, but because we typically rely on technology like calculators and spreadsheets to do this, it might take us a while to call up the relevant mental processes and do it on our own. What if you were asked, without warning, to do this under stressful and time-critical conditions? The risk of error would be considerable.

This was the challenge that the crew of AF447 faced. But they also had to deal with certain “automation surprises,” such as technology behaving in ways that they did not understand or expect.

The point here is the technology offering up the “automation surprises” was doing exactly what it was programmed to do. The technology did not fail; the pilots, all three of them, failed in their response to the “surprises.”

We are now at the beginning of a monumental shift in the way work (and play) is done. The natural gravitational movement of artificial intelligence assuming more and more control in our daily lives is unstoppable. Think of how it has brought tremendous improvements in air safety. To prove that, consider this astounding statistic: In 2016 the accident rate for major jets was just one major accident for every 2.56 million flights. But this bubble of safety can breed terrible complacency. How humanity deals with and prepares for the rude “automation surprises” that will surely come along on the way to the future should be a critical component in the thinking of organizational leaders and safety professionals.

 

News Roundup: Health Wonk Review and news from our bookmark file

September 15th, 2017 by Julie Ferguson

loudspeakers

Health Wonk Review kicks off the fall season with The Neverending Summer of Healthcare Legislation Edition posted by Louise Norris at Colorado Health Insurance Insider. It unfolds against the backdrop of the continuing ACA saga, with not one but two new bills introduced: Senator Sanders’ single-payer bill and Senators Lindsey Graham, Bill Cassidy, Dean Heller and Ron Johnson’s ACA repeal/replace bill. This issue covers single payer, opioid abuse, drug pricing, hurricane recovery workers, hospice care, medical innovations, the return of hookworm in the US, and more.

Louise has a sterling reputation as an informed commentator on the evolving ACA matters, contributing to a variety of blogs. If the ACA ison your radar, be sure to see her many entries at healthinsurance.org.

Meanwhile, in the midst of the ongoing debate, it is worth noting that 3 years after the Affordable Care Act’s coverage expansion took effect, the uninsured rate fell to a record low of 8.8%, in contrast to 17% in 2009. The number of people without healthcare insurance fell to 28 million, down from 50 million. The number of uninsured fell dramatically from 42 million in 2013 to 28 million today, when the ACA allowed states to expand Medicaid coverage to low-income people.

Other news of note from our bookmark file

Think you’re an informed health wonk? Test your knowledge in this Kaiser Health News Quiz: How Well Are You Paying Attention?

NCCI: Recovering From a Nightmare: Assaulted Employee Returns to Work in 10 Weeks

Joe Paduda: Costs & Benefits of Disasters and Big changes a-coming in workers’ comp.

Roberto Ceniceros at Risk & Insurance: Ergonomic Sense

Jordan Barab: OSHA Covers Up Workplace Fatalities

Jordan Barab: Undercover: Working and Dying as a Temporary Employee

Bob Wilson: God Vacations in Sarasota, or, What I Learned from Hurricane Irma

ESPN: “Who Does This To People?”

Kudos to our friends at Insurance Recovery Group in naming Paul James as new CEO and President. IRG specializes in subrogation, second injury fund, COLA recovery, and cost containment in work comp and other property/casualty disciplines.

Chikita Mann at WorkCompWire: Cultural Competency and the LGBTQ Injured Worker

Ken Ward: Trump nominates former coal exec to run MSHA and Democratic leader calls for scrutiny of Trump’s mine safety nominee

Cal/OSHA’s disappearing funds – where’s the money?

Workers compensation renewal rates remain negative

Gig Economy Workers May See Benefits Relief via Portable Benefits for Gig Economy Workers Act

WCRI Study: Fewer Injured Workers Prescribed Opioids After Kentucky Reforms

Overtime rule scrapped but there’s likely to be a new one

House approves bill to speed autonomous vehicle development

Scanning The Future, Radiologists See Their Jobs At Risk

Medical school debts run $180,000 on average per student

Check out this clip of the world’s first drone equipped with robotic arms

And in more technology developments, the chairless chair

One of America’s Most Dangerous Jobs

September 13th, 2017 by Julie Ferguson

Kicked, pummeled, taken hostage, stabbed and sexually assaulted … would you want a job that included these risks? In One of America’s Most Dangerous Jobs, the Washington Post shines a spotlight on the dangers in the nursing profession, specifically around the violence that they encounter on the job. Citing a recent GAO report on violence in healthcare profession, the article notes that, “the rates of workplace violence in health care and social assistance settings are five to 12 times higher than the estimated rates for workers overall.”

Here’s one excerpt from the article:

“In Massachusetts, Elise’s Law, which is named for the nurse who was attacked in June, is already on the fast track to set state standards for workplace protection. Legislators were working on this months before Wilson was stabbed.

Nurses in Massachusetts were attacked more frequently than police or prison guards. When association members testified about the violence epidemic this spring, they said nurses had been threatened with scissors, pencils or pens, knives, guns, medical equipment and furniture in the past two years alone, according to the Massachusetts Nurses Association.”

OSHA reports that in surveys conducted by various nursing and healthcare groups:

  • 21% of nurses and nursing students reported being physically assaulted and over 50% verbally abused in a 12-month period
  • 12% of emergency department nurses experienced physical violence and 59% experienced verbal abuse during a seven-day period
  • 13% of employees in Veterans Health Administration hospitals reported being assaulted in a year

 

While 26 states have workplace safety standards for health-care facilities, there are no federal standards. Nursing groups say that state efforts have helped increase awareness.

NIOSH worked with various partners – including nursing and labor organizations, academic groups, other government agencies, and Vida Health Communications, Inc. – to develop a free on-line course aimed at training nurses in recognizing and preventing workplace violence. The course has 13 units that take approximately 15 minutes each to complete and includes “resume-where-you-left-off” technology. Learn more about the courses at Free On-line Violence Prevention Training for Nurses and the actual course can be accessed here: Workplace Violence Prevention for Nurses CDC Course No. WB1865

Related

 

 

 

Fresh Health Wonk Review & a summer news roundup

August 17th, 2017 by Julie Ferguson

Fresh Health Wonk Review! Looking for some beach reading? The wonks have you covered. Peggy Salvatore posts The Summer Lull Edition of Health Wonk Review at Health System Ed blog – catch up on what’s been happening in the last few weeks, from autopsies of the ACA repeal to where we go from here and assorted other health topics, the wonks have you covered – check it out.

man reading laptop on a beach

 

More summer reading:

Healthcare reform implications for work comp – Not included in this week’s HWR but a must-read nonetheless, in a two-part series at Managed Care Matters, Joe Paduda breaks down the likely implications for workers comp, Medicaid Expansion and more. Part one is linked above, and here is part 2.

They Got Hurt At Work — Then They Got Deported – Most workers comp laws have upheld workers comp for workers regardless of status: if the employer had the benefit of the labor and the worker is injured, generally comp will pay for those injuries. NPR looks at how that is changing and how some state laws are targeting undocumented workers.

Opt Out is Going to Return, and Why We Should Pay Attention – Think opt out was killed with the OK Supreme Court decision? At Bob’s Cluttered Desk, Bob Wilson talks about why that’s not likely and where the debate is going from here.

WCI 2017 – Miss the recent conference? Here are a few folks who have you covered: WCI has a good conference roundup and Conference Chronicles features good recaps of sessions.

Mourning writer Lizzie Grossman: The Pump Handle readers will miss her – We were sad to learn of Lizzie’s passing, a journalist and blogger who covered important environmental health issues. Her voice will be missed.

Quick Takes

 

In closing, Apparently, robots aren’t quite ready to take our jobs