Posts Tagged ‘heat’

News Roundup: New must-read blog, opiate epidemic, nurses impact on claim costs & more more

Friday, June 12th, 2015

We’re catching up on the news with a Friday roundup — but first and foremost, we issue a warm welcome to Dr. Jennifer Christian, who has a new blog. Here at Workers Comp Insider, we’re unabashed fans of Dr.C – we have no doubt that her blog will be one to follow. See her recent post: Why aren’t we saying and doing THESE THINGS about the ADA?

Quest Data Shows Rise in Positive Test Rates for Workplace Illicit Drugs – Caroline McDonald, Risk Management Monitor: “Organizations in the United States that tested employees for drugs saw a 9.3% jump in the number of positive drug tests for illicit drugs in the general workforce, to 4.7% in 2014 from 4.3% in 2013, according to data from Quest Diagnostics. These results may mark a rising trend, as 2013 was the first year since 2003 in which the overall positivity rate for about 1.1 million tests increased in the general U.S. workforce. The analysis shows a potential reversal of a decades-long decline in the abuse of illicit drugs in the U.S. workforce, Quest said.”
Related:
NPR – Emergency Rooms Crack Down On Abusers Of Pain Pills
MCN: A Changing Landscape: America’s Opiate Epidemic
Boston Health News: Much Massachusetts news on the #heroin #overdose epidemic and #opioid abuse
Paradigm: Two New Approaches to Curbing the Opioid Epidemic

Health care cost drivers, or, Here’s where you’re getting screwed – Joe Paduda of Managed Care Matters covers two recent studies in Health Affairs and their likely effect on workers comp costs: one indicating that orthopedic fees paid by private insurers are measurably higher in those markets with higher concentration and the second on hospital markups, the 50 hospitals with the highest charge to cost ratios.

Proving Value – Roberto Ceniceros, Risk & Insurance: “Sellers of workers’ compensation products that fail to grasp shifting marketplace dynamics or help buyers with the pressure they are under will increasingly lose to competitors.
You can see evidence of these changing dynamics in the challenges workers’ comp underwriters face. Their inability to earn adequate investment income is reshaping their view of the vendors they buy from.
Other buyers, including third party administrators and self-insured employers, are also re-evaluating their purchasing arrangements.”

How do nurses impact workers’ comp claim costs? – Melissa Hillebrand, PropertyCasualty360.com: “Medical and total loss dollars are reduced by double digit percentages when nurses become involved on a workers’ compensation claim, according to a report from Liberty Mutual Insurance and its wholly owned third-party administrator, Helmsman Management Services.
Based on the findings from an internal study of 42,000 claims, a nurse’s participation in the workers’ comp process decreases a claimant’s future medical costs by 18% and overall costs by 26%. The study, “The N Factor: How Nurses Add Value to Workers’ Compensation Claims,” pulled data points across four categories.”

South Dakota Supremes Declare Horseplay Compensable: Bob Wilson, Bob’s Cluttered Desk: “Workers’ compensation is no stranger to stupid stories. Lord knows we have seen our fair share of inane dumbassery. This story – make that this court decision – would be one of them.”

Overview of California Workers’ Compensation SystemConference Chronicles presents a recap of Dave Bellusci’s overview of California’s workers’ compensation system from the Workers’ Compensation Insurance Rating Bureau of California’s (WCIRB) perspective. Dave is the WCIRB Chief Actuary.
Related: Dave DePaolo offers his perspective on the WCRIB goings-on on two posts: The Whole Person and The Value Image.

Cognitive Therapy, Cognitive Dissonance – Michael Gavin, Evidence Based: “”One of the most frequent recommendations I see resulting from our peer-to-peer discussions on chronic pain claims is Cognitive Behavioral Therapy (CBT). CBT is a short-term, goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem-solving. Its goal is to change patterns of thinking or behavior that are behind people’s challenges and, thus, change the way they feel about and deal with those challenges.
Despite the growing body of evidence regarding the effectiveness of Cognitive Behavioral Therapy, it still seems to cause a great deal of cognitive dissonance in our industry. We want to mitigate chronic pain symptoms for injured workers so they can take fewer medications, have a higher quality of life, and perhaps even return to work. But we’re resistant to the idea that 6-12 CBT sessions can actually help with those goals, despite what the evidence suggests.”

Heat Hazard – Claire Wilkinson, Terms + Conditions – offers a variety of links to the growing risk posed by excessive heat and drought in various parts of the globe and in various industries.
Related: California Employers Take the Heat . . . of new Revised Heat Illness Standards

Other noteworthy news

Sugar: Bad for Consumers, Deadly for Workers?

Sunday, October 14th, 2012

It would be pretty hard to avoid the news about sugar: it’s bad for us. Diets high in sugar contribute mightily to the nation’s burgeoning problems of obesity and diabetes and may even be a factor in dementia. But sugar in its crop form is also proving to be deadly. The cause and effect, however, is as murky as a cloudy day in the rainforest.
Will Shorr has written a remarkable, hands-on article in the Guardian, examining the high rates of chronic kidney disease (CKD) among the workers who grow and harvest sugar cane in Central America. CKD is the second leading killer of men in El Salvador.
Why are sugar cane workers succumbing to kidney disease? Is it the working conditions? Is it the pesticides? Is it the diet of the workers? Fingers are pointing in a number of directions, and by the time the truth is sorted out, we may well find a toxic trail that includes of all three factors.
Dehydration
Nicaragua Sugar Estates, one of Central America’s largest plantations, has conducted its own internal studies, one of which identified one potential factor in the disease: “strenuous labour with exposure to high environmental temperatures without an adequate hydration program.” .Nonetheless, a company spokesman denies the connection: “We’re convinced that we have nothing to do with kidney disease. Our productive practices do not generate and are not causal factors for CKD.”
But researchers in the US have connected CKD to heat stress and dehydration. A standard day for an El Salvadorian sugar worker lasts between four and five hours, with double shifts during the summer planting season, when temperatures top out at 104 degrees.
Shorr quotes Héctor García, a 33 year old with stage-two kidney failure: “It’s very hot; we suffer. People sometimes collapse. More often they vomit, especially when the heat is worse. They do two shifts to earn more money.” Another worker, 40 years old and close to death with stage five CKD, reported the same symptoms, compounded by the limited resources in his home: “When I come home, I feel surrendered. Sick. Headache. I can’t shower because the water [from the roof-mounted tank] is too hot.” The image of the hand-rigged shower, full of very hot water, epitomizes the wretched living conditions of the workers.
Compounding the problem, most CKD sufferers do not even know they are ill: the disease is asymptomatic until its last, most deadly stages. Even when they feel unwell, many workers go into denial – they feel helpless, as they cannot afford the medication or the recommended diet of fresh vegetables and chicken breast. Dialysis – the last hope of the ill – is often avoided, because most of the workers who go on it end up dead anyway, so it appears to their co-workers that dialysis causes the death.
Chemicals
Researchers have found rates of CKD in cane cutters and seed cutters – the most strenuous jobs – to be higher than in pesticide applicators, who have greater exposure to agrochemicals. This seems to indicate that the pesticides are not a significant factor. But this conclusion may be premature.
Five chemicals are used in the cultivation of sugar cane: amine, terbutryn, pendimethalin, 2,4-D and atrazine. Shorr sent the chemical recipe for the yellow potion he observed being sprayed on the crops to Professor Andrew Watterson of the University of Stirling – an authority on agrochemicals and health. They were all herbicides, he noted. Watterson came up with a litany of potential problems:

Atrazine can cause kidney damage at high levels; acute exposure to 2.4-D can cause chronic kidney damage; pendimethalin is “harmful through skin contact and inhalation”; in lab tests, long-term feeding of terbutryn to rats caused kidney damage. None of them are acutely toxic, but this combination, plus the tropical climate, could worsen their effects.

On the prevention side, sprayers are supposed to avoid contact with skin; to wear face shields, respiratory protection, rubber boots and specialist coveralls. We can only surmise that such protective equipment, while technically useful, would be difficult to use in 100 degree weather. On the other hand, assuming the sprayers are protected, other workers do not wear protection and may thus experience greater exposures to the chemicals.
Sugar in the Diet?
Shorr concludes his article with a shocking new study that points in yet another direction. Richard Johnson, of the University of Colorado’s Division of Renal Diseases and Hypertension, thinks the problem might have its genesis in a mechanism that his team discovered in rats. Johnson speculates that if dehydrated workers with already sugary kidneys are rehydrating with soft drinks or fruit juice, they may experience a potentially explosive fructose load. He adds that “it’s not proven, so we don’t want to get ahead of the gun here [rather unfortunate metaphor].” The research has not as-yet been published. But Johnson goes on to say that the experimental data is quite compelling, and it “could explain what’s going on.”
It would truly be ironic if the cane field workers were dying from kidney failure in part because they use sugary soft drinks to rehydrate. “Buy the world a Coke” indeed!
Collateral Damage?
While it is too early to draw definitive conclusions, the Guardian article identifies at least three converging factors in the high CKD rates among field workers: extremely high heat compounded by hydration problems; a mix of potentially harmful pesticides; and an unhealthy diet too full of sweetened beverages. Add the impoverished living conditions of the workers – and marginal medical care – and you have all the makings of an abbreviated lifespan.
The US gets 23% of the its raw sugar from Central America; the European Union spends more than €4.7m on this import. Sugar is El Salvador’s second-biggest export. This is big business. With so much money at stake, the dying workers are little more than collateral damage. It appears that what they really need is an ample supply of clear, cool water, but such a simple remedy, alas, is nowhere in sight.

Cool Tools: Heat Safety App for Outdoor Workers

Tuesday, August 7th, 2012

Will the extreme heat that has plagued the nation in June and July continue on through August? If so, there’s a tool that might provide some relief — and safety — for outdoor workers.
OSHA has a Heat Safety App that allows workers and supervisors to calculate the heat index for their worksite and, based on the heat index, displays a risk level to outdoor workers. It combines heat index data from the U.S. National Oceanic and Atmospheric Administration with the user’s location to determine necessary protective measures.
Once a worker has determined the risk level, they can then access information about protective measures that should be taken for that risk level to prevent heat-related illness. These include reminders about drinking enough fluids, scheduling rest breaks, planning for and knowing what to do in an emergency, adjusting work operations, gradually building up the workload for new workers, training on heat illness signs and symptoms, and monitoring each other for signs and symptoms of heat-related illness.
osha-heat-app
The free app is available for iPhones, Androids, and Blackberrys in English and Spanish. Access other tools and information in OSHA’s Campaign to Prevent Heat Illness in Outdoor Workers.
USA Today has a story on how businesses are adapting to extreme heat and drought. It includes mention of some new “personal cooling system” technologies such as CoolWare and Polar Products, which offers some “Body Cooling Systems.” We can’t personally vouch for any of these because we haven’t tried them – but there are still several weeks to summer yet!

Health Wonk Review and other noteworthy news

Thursday, May 27th, 2010

Fresh Health Wonk Review – David Williams has posted a packed & pithy edition of Health Wonk Review over at his Health Business Blog – get your biweekly fill of the best of the health policy blogs.
Social media – Peter Rousmaniere has a roundup of some of the best workers’ comp social networking on the web at Risk and Insurance – we thank him for including us – check out some of the other resources!
Surgical implants – As Joe Paduda is consistently excellent about pointing out, when it comes to work comp medical costs, the devil is in the details. In a recent post, Joe tackles the high cost of surgical implants – a cost that is far higher under workers comp than under group health – and explains payer approaches to resolving the problem, and why they fall short. His advice? “Don’t reimburse based on the invoice. Period.”
Oil spill safety resources

State comp agencies – Roberto Ceniceros posts about struggling comp agencies on his Comp Time blog, a followup to a more in-depth article about how states’ financial woes are squeezing comp systems that appeared in Business Insurance. The recession has decreased payrolls, adding further momentum to the drop in frequency and theoretically resulting in fewer claims to process. But some employers report that state work comp cutbacks are impacting their ability to resolve claims. Some risk managers say that the shortage of administrative judges means that claims take longer to resolve, hearings are delayed, and litigation costs are higher, among other effects.
EBT cards spark suit – In Ohio, the Bureau of Workers Comp is paying workers comp benefits via a Chase debit card. A class action suit has been filed by employees who say that Chase is charging fees if they make more than one withdrawal a month. Many state agencies are using such cards for food stamps and other social programs but we were unaware that they are being used for workers comp. As one of just a handful of monopolistic states, Ohio is the exclusive provider of workers comp, so it makes sense that the state would want to cut administrative costs. Check out the 2004 white paper by the California Commission on Health and Safety and Workers’ Compensation: the Cost/Benefit of Implementing Electronic Deposit for Unemployment and Disability Benefits in the State of California.
Heat wave – If the recent record high temperatures in the northeast are any indicator, it could be a long hot summer. The Texas Division of Workers Compensation reminds employers to prevent heat related injuries and offers a good check list of safety tips to prep for extreme heat.

Health and safety news from the blogosphere

Wednesday, August 26th, 2009

Money-Driven Medicine – Maggie Mahar, one of the regular Health Wonk bloggers who we admire, is author of the book Money driven medicine: the real reason health care costs so much. Her book has been made into a documentary by Alex Gibney, the producer noted for his documentary expo Enron: The Smartest Guys in the Room. This Friday night, Bill Moyers Journal will preview excerpts of Money Driven Medicine, which Moyers cites as one of the strongest documentaries he has seen in years. It bears checking out. For more about the documentary, including a trailer, see moneydrivenmedicine.org. You can also follow Maggie’s blog posts at Health Beat.
Meanwhile, in Business Insurance, Joanne Wojcik writes that two surveys project that healthcare benefit costs will increase by more than 10% in 2010. Aon Consulting projects an average 10.5% increase, while Segal Co. sees cost increases ranging between 10.2% and 10.8% for managed care plans.
Nanoparticles – the NIOSH Science Blog highlights recent research related to occupational disease and nanoparticles. Nanotechnology is the discipline of technology that works at a molecular level with particles that are less than 100 nanometers in size. Earlier this year, the CDC released Approaches to Safe Nanotechnology (PDF), which offers recommendations for specific precautions to protect workers who are exposed to any level of nanoparticles. Learn more about research and risk management at the NIOSH Nanotechnology site.
Fatal SunshineTime recently featured an article on the plight of California farm workers, who frequently do not have adequate protection from heat stroke and basic precautions to prevent heat-related illness. While California state law mandates heat stress standards, many employers do not adhere to those standards. The ACLU and the law firm Munger, Tolles & Olson are suing California’s occupational health and safety agency on behalf of the United Farm Workers, workers who became sick, and relatives of workers who died from heatstroke.
Employer Pandemic Planning – While there are dueling projections for the potential impact of the H1N1 flu this fall and winter, it pays to be prepared. Safety Daily Advisor offers an abbreviated workplace pandemic planning checklist based on CDC recommendations. For more detailed planning information for work and home, see Flu.gov.
More on work suicides – We noted last week that a recent Bureau of Labor Statistics report showed that workplace suicides increased by 28% in 2008. At Comp Time, Roberto Ceniceros looks at the issue of workplace suicide in light of a recent Indiana appeals court ruling in which a widow was denied benefits related to her husband’s suicide.
Taking the job home – Jon Gelman blogs about a recent CDC study showing that workers who are exposed to lead can transport it home. The CDC suggests certain precentive measures to minimize risk to other family members.
Fitness for Duty – Fred Hosier of SafetyNewsAlert posts about how to deal with employees who are consistently unsafe through a comprehensive fitness for duty program.
OSHA – Is OSHA back in the business of enforcement? The Safety Duck thinks that issuance of 142 citations and $576,000 in penalties against Sims Bark Co. and Sims Stone Co. signifies that it is.

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

Heat stress rules go into effect in Washington, California

Thursday, June 28th, 2007

For the second year in a row, Washington is implementing an emergency heat-stress rule designed to protect outdoor workers. It took effect on June 5 and will run through October. The rule requires employers to provide outdoor workers with a quart of drinking water per hour, to educate employees about risk factors for heat-related illness, and to have some area to treat workers who exhibit heat-related symptoms, such as shade canopies or air conditioning.
The Department implemented the rule after the death of an agricultural worker from heat-related stress in 2005; in 2006, a construction worker died on the job while working in a trench, further solidifying the Department’s resolve about the need for such a measure.
Unsurprisingly, the measure is unpopular with several business groups, which view the rule as both needless and an intrusive layer of bureaucracy. An additional bone of contention is that business had no input into the measure. At the end of this season, the state’s Department of Labor & Industries plans to establish a permanent rule and to seek public input in the process.
California regulation was the pacesetter
Washington is not the only state with such a measure. In 2006, California became the first sate to adopt a heat stress regulation after a spike of 13 heat-related deaths in 2005. In a reminder to employers for the coming season, Cal/OSHA reviews the basic provisions:

Under the new heat illness regulation, employers are required to take four basic steps to prevent heat illness at all outdoor worksites: develop and implement written procedures on heat illness prevention; provide heat illness training to all employees; make readily available and encourage each employee to drink four 8-ounce cups of fresh water per hour; and provide immediate access to shade or any cool area out of the sun for recovery periods for at least five minutes at a time.

Coming to a state near you?
Could such regulations be the beginning of a trend that will move to other states? Last year, the Centers for Disease Control and Prevention issued a report which showed that heat-related deaths are increasing, although some think that the increase can be attributed to better tracking. The report is not specific to workplaces, but if the numbers of heat-related deaths continue on an upward trend, it is possible that we may see an increase in state efforts to protect at-risk populations, including workers
Wise employers who have outdoor workers will look to control risk and prevent heat-related illness, regardless of state mandates. Any time the temperature exceeds 90 degrees, workers should be protected. In addition to providing sufficient water and access to shade, employers should be on the alert for employees with high risk factors. Acclimation to the heat is very significant – a new worker or a worker returning from vacation is at greater risk than a worker who has been acclimated to the heat over a few weeks. Many cases of heat stress occur to workers on the first day of the job. Other risk factors may include pre-existing medical conditions – obesity, diabetes, and heart, lung and kidney disease. Workers who are on medications and workers who are nursing hangovers may be at risk because they are starting work already in a dehydrated mode. OSHA has a Quick Card on Heat Stress (also in Spanish), as well as a Fact Sheet about Working Outdoors in Warm Climates(PDF) that includes prevention tips for heat stress, along with other outdoor hazards.
Additional resources
California – Heat related illness prevention and information
Washington – Outdoor Heat-Related Illness (Heat Stress)
OSHA Technical Manual on Heat Stress
Heat Illness in the Workplace: How You Can Control the Risk
CDC Frequently Asked Questions About Extreme Heat
Heat stress: fluid and electrolyte balance can be fatal