Posts Tagged ‘cancer’

9/11: A 15 Year Remembrance

Friday, September 9th, 2016

On September 11, 2001, the nation took the biggest of gut-punches. Thousands died that day and hundreds of thousands, all around the world, have died since. If you were in the insurance industry that day, you probably lost at least one friend, maybe more. I know I did. The world changed after that day, and barbarism raised its head like a volcano rising from the crash of tectonic plates.

First Responders have been particularly savaged. More than 5,000 have been victimized by cancer. Dr. Michael Crane, the head of New York’s Mount Sinai Hospital’s 9/11 Health Program Clinic estimates he sees ten to fifteen new cases per week. Today, CBS This Morning told the story of one of them, Sal Terderici. It is heartbreaking.

We all sought healing in our own ways. Because I’m a musician and a singer, I sought to deal with the tragedy by writing an anthem about it. I recorded it in Worcester’s Mechanics Hall and renowned guitarist Peter Clemente accompanied me. We gave the song to Denis Leary, a Worcester native who had lost a cousin, a firefighter, as he battled the Worcester Cold Storage and Warehouse Company fire in 1999. Five of his cousin’s comrades also died in that fire. Denis became passionate about helping firefighters following that. You may recall his hit TV show, Rescue Me, which ran on FX from 2004 through 2011. Rescue Me was a seven year homage to a noble profession. Denis took our song and used it to help raise money for the fallen firefighters of September 11.

This coming Sunday will mark the 15th anniversary of, arguably, the worst day in American history. To mark the event, I want to share our anthem with you. You can find it here.

Tom Lynch

Health Wonk Review, Irish style, and other noteworthy news briefs

Thursday, March 15th, 2012

Guinness is good for you – That’s the news from Tinker Ready, who is hosting the Health Wonk Review: Wearing the Green for the St. Patrick’s Day Edition at her blog Boston Health News. We think it’s pretty fitting to have a Boston blog hosting this particular edition!
From the bizarre file – Thomas A. Robinson ofRisk Management Magazine offers a list of the 10 most bizarre workers compensation cases during 2011. Robinson rightly notes that, “Despite their unusual nature, however, one must always be respectful of the fact that while a case might be bizarre in an academic sense, it was intensely real, affecting real lives and real families.” So true. We hope he’ll follow with a collection of the 10 most bizarre employer acts – we’ve seen a few in our day.
OSHA whistleblowers – Just a reminder: Don’t fire someone for reporting safety hazard. A Florida charter school is learning this lesson the hard way. OSHA is suing Manatee School for the Arts in Palmetto, Fla seeking reinstatement of the former employee with full benefits; payment of back wages, punitive damages, and compensatory damages, among other things.
New York’s Reg. 194 – There’s a big brouhaha in New York over N.Y. Reg. 194, with risk manager groups and agent groups coming down on opposite sides of the fence. N.Y. Reg, 194 is a broker-disclosure rule that requires agents to advise clients that they receive commissions from insurers. The ruling was proposed by the Division of Insurance in the aftermath of the Spitzer investigations against several large brokerage firms. Last week, a NY Appellate Court upheld the rule.
Exploding pig farms – We posted a link to this issue before – but the mysterious hog farm explosions continue to stump scientists. A strange, potentially explosive foam is surfacing near manure pits in about 1 ou tof every 4 hog farms, and has caused six explosions since 2009. According to the article: “This has all started in the last four or five years here. We don’t have any idea where it came from or how it got started,” said agricultural engineer Charles Clanton of the University of Minnesota. “Whatever has happened is new.” The National Hog Farmer has more background: Foaming swine manure poses explosive risks.
Wellness focus – Of cancers affecting both men and women, colorectal cancer (cancer of the colon and rectum) is the second leading cancer killer in the United States, and the number one cancer killer in non-smokers. Why not issue a reminder to your employees: Colorectal cancer screening saves lives.
Market conditions – Roberto Ceniceros notes that captives are thriving as the work comp market hardens. Rising prices for traditional insurance vehicles always means that alternative insurance programs see growth.

Cavalcade of Risk & workers comp news briefs

Wednesday, January 12th, 2011

It’s Cavalcade of Risk week and issue #122 is hosted by our friend David Williams at Health Business Blog – check it out!
Industry pulse – Good news. Robert Hartwig of the Insurance Information Institute takes the pulse of the property casualty industry and sees signs of life: Insurance Industry On The Mend. “Mr. Hartwig said in comparison to all of 2009, the industry’s 2010 third-quarter results are close to all of the prior years. While the industry is not back to where it was prior to the economic downturn in 2007 when it reported property and casualty net income of $62.5 billion, it is performing significantly better than the worst of the downturn in 2008 when p&c income came in at slightly more than $3 billion.”
That’s good news, but it’s not time to break out the champagne yet. A.M. Best forecasts downward rating pressure for the commercial market and two new reports indicate that reinsurance prices should remain soft in 2011.
Physician dispensed drugs – If you are an employer or an insurer and this topic isn’t yet on your radar, it needs to be. Joe Paduda posts about recent NCCI report on physician-dispensed drugs in workers comp, a significant growth area that NCCI says is putting upward pressure on WC costs. California took steps to regulate the practice a few years ago after learning that repackaged costs were two to twelve times higher than the fee schedule.
Labor – The New York Times reports that cash-strapped states are looking to curb labor unions. Expect a flurry of legislative initiatives to limit the power of labor unions representing government employees. While both parties are wrestling with ways to keep state budgets in line, the article notes:
“But in some cases — mostly in states with Republican governors and Republican statehouse majorities — officials are seeking more far-reaching, structural changes that would weaken the bargaining power and political influence of unions, including private sector ones.”
Prevention works – A concerted campaign to reduce textile service worker injuries is working, according to the recently released annual TRSA Textile Services Industry Safety Report. Recordable injuries and illnesses dropped by 17 percent from 2008 to the 2009, and have dropped by 50% since 2005. Sandy Smith reports on SafeTRSA, an industry-wide safety initiative to improve worker safety through awareness, education and training.
Breast cancer & comp – At Comp Time, Roberto Ceniceros discusses City of Las Vegas v. Lawson. The Nevada Supreme Court ruled that a firefighter is entitled to a presumption that her breast cancer arose from her on-the-job exposure to benzene. His post also discusses male breast cancer.
Dramatic Australia flood footage – Office workers catch footage of a modest creek turning into a raging torrent sweeping cars away. More news and dramatic videos of the cataclysmic Australian flooding is available on MSNBC. At least 16 people are reported dead and more than 90 missing in what has been likened to an inland tsunami. Brisbane is under siege. You can follow breaking news on Twitter at #Brisbane.

“The touch of a human hand and tone of voice can do so much in the process we call healing”

Thursday, January 6th, 2011

As long as we’re on the topic of healthcare today, it seems to be an opportune time to share a moving video clip that we bookmarked over the holidays. Marty Ratermann, a Missouri a craftsman and furniture maker, relates his story as a cancer patient at the 2010 Health Literacy Missouri Summit. He was diagnosed with Stage 4 rectal cancer in 2008. After a grueling recovery process, he has been in remission for more than a year. He details how his situation could have been prevented with better communication between him and his doctors.
His story illustrates the difficult path that a person faces navigating the complex healthcare system and making critical choices at a point when he or she is particularly vulnerable. His prescription at the end of the clip is a simple one: take the time and make it a priority to communicate.
I couldn’t help but think of the parallels in the healing process for workers who have experienced a serious injury. Many a claim has spiraled out of control for want of good, clear communication and a simple human-to-human moment of concern. So often, we see workplace injuries that are treated as financial transactions when, in reality, they are fundamentally human events: someone is injured, often through no fault of their own. The complexity of the system a worker may find themselves suddenly thrust into, the unfamiliar insurance jargon, the impersonality – all occurring at a point where the worker may be feeling fear and anxiety about their future physical and financial well being. Our prescription: Less thinking about the injured worker as a claimant and more thinking about them as a person. In our experience, that’s what leads to the best financial outcomes in the long run.

A Patient’s Story from Health Literacy Missouri on Vimeo.

Compensable Sunshine, Revisted

Tuesday, May 26th, 2009

Our blog last week linking skin cancer to workers comp has already generated a few comments. “Workers comp attorney” raises some interesting questions:
(1) How much weight do you give to the person’s leisure activities and/or length of employment? It seems these would certainly be factors in assessing whether the employment is the predominate cause.
When assessing the work-relatedness of skin cancer, claims adjusters will look carefully at non work exposures: hobbies such as hiking, fishing, boating, outdoor sports, surfing, swimming or simply tanning. Balanced against these exposures will be the work setting: outdoors all the time (eg, roofing, migrant farm work, paving) or just incidentally (framing carpentry).
While the case law is still rather limited, there are examples of compensable skin cancers involving a limousine chauffeur (!) in New York and an architect in Texas. [NOTE: a sun screen manufacturer, unsurprisingly, is keeping close track of case law developments!] It is safe to assume that the burden of proof remains on the employee to show that the cancer is work related, but this burden is now supported by substantial medical evidence. Indeed, the existence of government funded education on the risk – here is a CDC link – would tend to support claims of compensability.
As far as length of employment goes, it usually does not matter. As in the case of repetitive motion injuries, the most recent employer is usually on the hook for coverage, even if the employee has only been working for a few weeks.
(2) What steps could employers take to prevent work-related skin cancer other than the mentioned provision of sun screen and policies to enforce dress code?
Employers should just stick with the basics: provide – and enforce the use of – sun screens; require head gear. In the vast majority of exposed workers, this is not happening. There is research showing an increase in skin cancers among Latinos. I wonder if this is related to the negative cultural images associated with protective gear. [NOTE: my teenage daughters hate my wide-brimmed sun hat. It’s just not cool!] [I wear it anyway.]
(3) What about research indicating that some, if not all, sunscreen products are carcinogenic?
While there is some evidence that tanning booths may be associated with cancer, I am not aware of any medical evidence to support a connection between sunscreens and cancer. In any event, the risk of not using a sunscreen far exceeds the risk of using one.
4) What balance should be sought between skin cancer and heat-related illnesses (if any “balance”) as far as prevention is concerned?
Skin and heat protection are not mutually exclusive. People have been covering up in desert cultures for centuries by wearing light colored, loose clothing and head gear. (I hardly need add that American workers would vehemently reject any protective measures that made them resemble middle-eastern sheiks!)
Proactive, Reactive, Inactive?
Another reader wonders how many companies have actually implemented the recommended preventive measures. That’s a great question. Judging by limited observation of workers in the sun, smaller employers have done little if anything to prevent risk. Any time I see a worker in the hot sun, shirtless and hatless, I assume that the cancer issue is simply being ignored.
What, if anything, will mobilize employers to take action to limit sun exposures? It usually comes down to money. Employers who operate in states that view skin cancer as potentially work related will eventually find it cheaper to provide (inexpensive) sunscreens and hats to their workers in the great outdoors. If state courts reject these claims, the workers will bear the burden.
Let’s hope that employers take action before the courts force the issue. We have a known risk and we have proven remedies. Reason says that employers, at a minimum, will immediately share this information with exposed workers. But then again, how often is the voice of reason heard in the American workplace?

Working Outdoors: Skin Cancer and Workers Comp

Thursday, May 21st, 2009

With the full heat of summer bearing down on us, the Insider has deputized its readership to become informal safety inspectors: the next time you leave the office, observe any people who are working outdoors. Your checklist should include the fundamental safety drill: fall protection for height exposures; personal protective equipment such as hard hats, work boots and goggles; secure scaffolds and ladders; proper use of machinery (lawnmowers, clippers, circular saws, etc.); proper lifting and efficient material handling.
Here is a safety issue that you are likely to observe in the breach: protection from skin cancer. Exposure to the direct rays of the sun, especially at midday, is a significant safety hazard. Alas, when most people labor in the full sun, they usually take action against the heat, at the expense of protecting themselves from the sun’s rays.
Cancer prevention dictates the wearing of long-sleeved shirts, a hat with neck flaps, sunscreen for exposed skin and sunblock for the nose and lips. When was the last time you saw a landscaper, carpenter or roofer dressed appropriately? When the heat rises, the shirts tend to come off. Bandanas and “do-rags” – considered cool in working circles – keep sweat out of the eyes, but they do little to protect the skin from the sun’s rays. Hats with flaps? Dude, you must be kidding. Goggles and hardhats? They are the first to go when the heat rises.
As for the advice to “avoid exposure between the hours of 10 am and 2 pm,” that is simply not going to happen. There is work to be done and those are prime hours for doing it. Siestas might be culturally acceptable in the tropics, but in our productivity-driven culture, siestas are not an option.
The Compensability Conundrum
As we have pointed out in prior blogs, the connection between work and occupational disease is often difficult to prove. With the exception of public safety employees, most workers face formidable odds in collecting comp for occupational diseases. There often are factors that mitigate against the acceptance of a claim: family history, smoking, fair skin, etc. Workers must be able to prove that workplace exposures are the “predominant cause” of the cancer. Sure, a laborer is under the sun at work; but he or she might also have significant exposure during leisure time, going to the beach, fishing, or just working in the garden.
It’s always interesting to see how state legislatures translate emerging hazards into proposed legislation: lawmakers tend to react in a limited, ad hoc manner. See for example this proposed bill in the New York legislature:

This bill would provide,with respect to active lifeguards employed, for more than 3
consecutive months in a calendar year, by certain local agencies and the Department of Parks and Recreation, that the term “injury” includes skin cancer that develops or manifests itself during the period of the lifeguard’s employment. This bill would further create a
rebuttable presumption that the above injury arises out of and in the course of the lifeguard’s employment if it develops or manifests during the period of the employment.

Note that the symptoms must develop during employment: this in itself may prove problemmatic, as many cancers occur some time after the direct exposure. Beyond that, the bill establishes a compensability presumption for one very limited class of workers, lifeguards. It does not address the myriad workers who face similar hazards on a daily basis (even if their work uniforms involve more than just a bathing suit).
Despite the fact that many workers will develop skin cancers which are likely to be work related, the number of compensable incidents will remain modest. The comp deck remains stacked against workers in the general area of illness.
Compensability and safety are two separate issues. We may not be able to do much about expanding coverage for work-related cancers, but we can take aggressive action to prevent them. It all comes down – as it does so often – to management: do you tolerate your workers’s ad hoc efforts to combat the heat, or do you enforce “best practices” in cancer prevention. Do you make sunscreens and head protection readily available on the jobsite, or do you allow your workers the “individual freedom” to do as they please?
We all know how most managers respond. They take the path of least resistance. The risk of an accident is one thing, the seemingly remote risk of illness is quite another. It will take many more tragic cases of work-related cancers before a true prevention mobilization takes place. For workers struggling under today’s galring sun, we can only hope that a word to the wise is sufficient.

Health Wonk Review, scaffold survivor update, hand protection, and potential cancer cluster

Friday, June 13th, 2008

Jane Hiebert White has posted a great edition of Health Wonk Review: Washington Week at Health Affairs – and she notes that this issue coincides with Academy Health’s Annual Research Meeting held in DC this past week, a gathering based on the concept that health policy should be informed by research. In this HWR issue, one of the major themes centers on health care reform. It’s worth your time to check it out – it may be one of our biggest and most substantive issues yet.
Survival story – at the beginning of the year, we posted about miracle survivor Alcides Moreno who lived through a NY scaffolding collapse which sent him plummeting 47 stories. Today, the New York Post features a story about Moreno entitled 47-story guy walking tall. But not all the news associated with this story is good: his brother who was also on the scaffold was killed in the fall. Earlier this week, The New York Times covered the OSHA report about the accident, which found fault with City Wide Window Cleaning, the service that employed the Morenos, and Tractel, the firm that had repaired the scaffold.

OSHA issued five citations against City Wide for what it called serious violations. Three carried proposed fines of $7,000 apiece, the highest the agency can impose. One was for lack of a system to protect against falls — cables that would have left the Morenos dangling at the top of the building when the scaffold gave way.

Another citation against City Wide was for failing to train employees in how to inspect the scaffold, and for not training them to wear “personal protective equipment” before they stepped onto the rig. The article lists other charges against both companies. Commenting about the fines imposed, the Daily News editorializes that death comes cheap, noting that, “Financial penalties like that are meaningless as a deterrent to corner-cutting by contractors.”
Hand injury prevention – According to an article on hand injuries by Don Groce in Occupational Hazards, gloves can prevent injuries and reduce costs. Recent research shows that “The cost of hand injuries in just one sector of the construction industry is six times what it would cost those employers to offer every employee appropriate hand protection.” This preventive measure represents potential to reduce pain, reduce lost productivity, and save dollars. According to the CDC, hand injuries account for more than a million emergency department visits by U.S. workers per year. Groce’s article also discusses advances in glove manufacturing and various types of safety glove alternatives.
Dupont cancer cluster? – Celeste Monforton of The Pump Handle raises the question of whether there is a cancer cluster associated with Dupont in response to 19 cases of rare carcinoid tumors among DuPont employees, with 6 of the cases surfacing among workers at the Washington Works plant in West Virginia. She reports that adverse health effects have been associated with exposure to perfluorooctanoic acid (PFOA or C8), the chemical used to make Teflon and other non-stick surfaces.

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.

IBM cancer lawsuit – exclusive remedy, workplace illnesses, and technology industry exposures

Sunday, February 29th, 2004

Last week a jury found in favor of IBM by denying damages in a suit filed by two retired workers. The workers alleged that exposure to chemicals and toxins at an IBM plant led to cancer. This case points to several issues that should be of interest to employers and to those of us who work in the field of workers compensation.

First, there is the tort issue. Normally, any compensability for work-related injuries or illnesses would be determined by the state workers compensation system. In that these illnesses arose out of and in the course of employment, why wouldn’t they fall under the prevailing jurisdiction’s exclusive remedy clause of workers compensation?

The answer to this question lies in the fact that almost every state has exceptions to the exclusive remedy doctrine that allow for workers to file tort actions. One common exception is willful intent on the part of the employer. That was essentially the basis of this particular lawsuit: the employees were trying to establish that IBM knew the potential hazard these chemicals represented, that IBM willfully disregarded that danger, and – very important to the California exception – that IBM neglected to inform the employees about that danger. Courts typically impose fairly high standards of proof in cases involving willful intent.

A second issue this case highlights is the difficulty in proving the work-relatedness of an illness. Injuries are generally easier to determine – they often entail observable events, such as a fall, a cut, or a burn. Illnesses may take years to develop. It may also be difficult to separate work-related factors that led to an illness from non-work factors. In the case of chemical exposures, a direct medical link between chemical exposure levels and an illness can be years in determination; even then, chemical agents may be in widespread use, making it difficult to isolate whether the workplace is the proximate cause of the illness.

The judgment in this case may well be a pyrrhic victory for IBM and for the chip industry. A series of 200 related suits from former workers about cancer and chemical poisening are still in the docket, as are about 40 suits involving birth defects in children of workers. The first birth defect suit against IBM will begin in New York next week.
We’ve been talking laws here, but at the heart of the matter is worker safety. The toxins involved in the chip making industry have been coming under scrutiny for several years now, and although there have been some industry efforts at self-policing and enhancing safety, hazards still exist that risk managers, health & safety practitioners, and the industry itself must still address. The fact that IBM has “won” this round does nothing to lift the moral mandate that every employer has to provide a safe and healthful workplace. And if one of the remaining suits finds success in another jurisdiction, the financial imperative may become more pressing as well.

Confined Space reports more on the safety hazards involved in this case, and also reports extensively on a proposed European initiative called REACH (Registration, Evaluation and Authorization of Chemicals) that increases the chemical industry’s responsibility for generating knowledge on chemicals, evaluating risk, maintaining safety standards, and substituting safer chemicals when possible.

More information:
Labor perspective from IBM Alliance
Tech industry reportage at Information Week
Toxic technology: Critics say chemicals used in making chips cause serious illnesses
Dirty secrets of the chipmaking industry
CCOHS: Health effects of trichloroethylene